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Case report
Insidious onset of headache, diplopia and Horner’s syndrome: a rare case of petrous bone osteomyelitis
  1. Simon Biart1 and
  2. Janki Panicker2
  1. 1 Acute Medicine, Arrowe Park Hospital, UK
  2. 2 Diabetes and Endocrine, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
  1. Correspondence to Dr Simon Biart, biart_si_123{at}


We present an unusual case of skull base osteomyelitis in an 88-year-old woman. She presented with gradual onset unilateral headache and diplopia. On examination, there was evidence of a left-sided Horner’s and ipsilateral sixth nerve palsy. In addition to persistent raised inflammatory markers, an MRI neck identified signal change in the petrous bone confirming a diagnosis of skull base osteomyelitis. Skull base osteomyelitis should be considered in presentations of subacute raised inflammatory markers in the context of ipsilateral cranial nerve signs.

  • cranial nerves
  • headache (including migraines)
  • infection (neurology)

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  • Contributors Case report planned by SB and JP. Written by SB, edited and amended by SB and JP.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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