Skip to main content

Advertisement

Log in

Skull base osteomyelitis and potential cerebrovascular complications in children

  • Pictorial Essay
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Skull base osteomyelitis is an aggressive, life-threatening infection that can be challenging to diagnose and treat. It occurs predominantly in elderly immunocompromised patients, but it has also been reported in children with normal immunological status. Typical skul base osteomyelitis arises as a complication to ear infection mainly involving the temporal bone and is usually caused by Pseudomonas aeruginosa. Atypical or central skul base osteomyelitis originates from paranasal infections, is primarily centred on the clivus and is usually caused by Aspergillus, Pseudomonas, Salmonella or Staphylococcus species. Potential complications include retropharyngeal abscesses, cranial neuropathies, meningitis, intracranial abscesses, sinovenous thrombosis, and carotid artery involvement with or without ischemic infarcts. The purpose of this pictorial essay is to illustrate the spectrum of imaging findings and potential complications of skul base osteomyelitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Rothholtz VS, Lee AD, Shamloo B et al (2008) Skull base osteomyelitis: the effect of comorbid disease on hospitalization. Laryngoscope 118:1917–1924

    Article  PubMed  Google Scholar 

  2. Sreepada GS, Kwartler JA (2003) Skull base osteomyelitis secondary to malignant otitis externa. Curr Opin Otolaryngol Head Neck Surg 11:316–323

    Article  PubMed  Google Scholar 

  3. Lee S, Hooper R, Fuller A et al (2008) Otogenic cranial base osteomyelitis: a proposed prognosis-based system for disease classification. Otol Neurotol 29:666–672

    Article  PubMed  CAS  Google Scholar 

  4. Rubin Grandis J, Branstetter BF 4th, Yu VL (2004) The changing face of malignant (necrotising) external otitis: clinical, radiological, and anatomic correlations. Lancet Infect Dis 4:34–39

    Article  PubMed  Google Scholar 

  5. Clark MP, Pretorius PM, Byren I et al (2009) Central or atypical skull base osteomyelitis: diagnosis and treatment. Skull Base 19:247–254

    Article  PubMed  Google Scholar 

  6. Laurens MB, Becker RM, Johnson JK et al (2008) MRSA with progression from otitis media and sphenoid sinusitis to clival osteomyelitis, pachymeningitis and abducens nerve palsy in an immunocompetent 10-year-old patient. Int J Pediatr Otorhinolaryngol 72:945–951

    Article  PubMed  Google Scholar 

  7. Arnold PM, Govindan S, Anderson KK (2009) Spontaneous cranial osteomyelitis in an otherwise healthy ten-year-old male. Pediatr Neurosurg 45:407–409

    Article  PubMed  Google Scholar 

  8. Mani N, Sudhoff H, Rajagopal S et al (2007) Cranial nerve involvement in malignant external otitis: implications for clinical outcome. Laryngoscope 117:907–910

    Article  PubMed  Google Scholar 

  9. Azizi SA, Fayad PB, Fulbright R et al (1995) Clivus and cervical spinal osteomyelitis with epidural abscess presenting with multiple cranial neuropathies. Clin Neurol Neurosurg 97:239–244

    Article  PubMed  CAS  Google Scholar 

  10. Klinge L, Vester U, Schaper J et al (2002) Severe Fusobacteria infections (Lemierre syndrome) in two boys. Eur J Pediatr 161:616–618

    Article  PubMed  Google Scholar 

  11. Monnier L et al (2008) Fusobacterium necrophorum middle ear infections in children and related complications: report of 25 cases and literature review. Pediatr Infect Dis J 27:613–617

    Article  PubMed  Google Scholar 

  12. Chirinos JA, Lichtstein DM, Garcia J, Tamariz LJ (2002) The evolution of Lemierre syndrome: report of two cases and review of the literature. Medicine (Baltimore) 81:458–465

    Article  Google Scholar 

  13. Visosky AM, Isaacson B, Oghalai JS (2006) Circumferential petrosectomy for petrous apicitis and cranial base osteomyelitis. Otol Neurotol 27:1003–1013

    Article  PubMed  Google Scholar 

  14. Hoehn KS (2005) Lemierre’s syndrome: the controversy of anticoagulation. Pediatrics 115:1415–1416

    Article  PubMed  Google Scholar 

  15. Seabold JE, Simonson TM, Weber PC et al (1995) Cranial osteomyelitis: diagnosis and follow-up with In-111 white blood cell and Tc-99 m methylene diphosphonate bone SPECT, CT, and MR imaging. Radiology 196:779–788

    PubMed  CAS  Google Scholar 

  16. Chang PC, Fischbein NJ, Holliday RA (2003) Central skull base osteomyelitis in patients without otitis externa: imaging findings. AJNR 24:1310–1316

    PubMed  Google Scholar 

  17. Parmar HA, Sitoh YY (2005) Diffusion-weighted imaging findings in central skull base osteomyelitis with pharyngeal abscess formation. AJR 184:1363–1364

    PubMed  Google Scholar 

  18. Taranath A, Prelog K (2005) Sella turcica collection due to skull base osteomyelitis. Pediatr Radiol 35:451

    Article  PubMed  Google Scholar 

  19. Rusconi R, Bergamaschi S, Cazzavillan A et al (2005) Clivus osteomyelitis secondary to Enterococcus faecium infection in a 6-year-old girl. Int J Pediatr Otorhinolaryngol 69:1265–1268

    Article  PubMed  CAS  Google Scholar 

  20. Prasad A, Madan VS, Suri ML et al (1992) Cryptogenic osteomyelitis of the skull and intracerebral abscess. Childs Nerv Syst 8:142–143

    Article  PubMed  CAS  Google Scholar 

  21. Prabhu SP, Zinkus T, Cheng AG et al (2009) Clival osteomyelitis resulting from spread of infection through the fossa navicularis magna in a child. Pediatr Radiol 39:995–998

    Article  PubMed  Google Scholar 

  22. Westhout F, Hasso A, Jalili M et al (2007) Lemierre syndrome complicated by cavernous sinus thrombosis, the development of subdural empyemas, and internal carotid artery narrowing without cerebral infarction. Case report. J Neurosurg 106(1 Suppl):53–56

    PubMed  Google Scholar 

  23. Hudgins PA, Dorey JH, Jacobs IN (1998) Internal carotid artery narrowing in children with retropharyngeal lymphadenitis and abscess. AJNR 19:1841–1843

    PubMed  CAS  Google Scholar 

  24. Ng J, Connolly DJ, Rittey CD et al (2007) Skull base osteomyelitis leading to lateral medullary syndrome in a child. Eur J Paediatr Neurol 11:111–114

    Article  PubMed  Google Scholar 

  25. Bentham JR, Pollard AJ, Milford CA et al (2004) Cerebral infract and meningitis secondary to Lemierre’s syndrome. Pediatr Neurol 30:281–283

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Andrea Rossi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Severino, M., Liyanage, S., Novelli, V. et al. Skull base osteomyelitis and potential cerebrovascular complications in children. Pediatr Radiol 42, 867–874 (2012). https://doi.org/10.1007/s00247-011-2340-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-011-2340-8

Keywords

Navigation