Description

A 13-year-old boy presented to his general practitioner, with right otalgia, mastoid tenderness and paresis of the right lateral rectus muscle. An MRI showed middle ear cleft opacification only and the patient was treated with oral ciprofloxacin, with resolution of symptoms.

Five months later, he developed a severe occipital headache and had difficulty flexing his neck, accompanied by fever and raised inflammatory markers. There were no signs of acute mastoiditis.

CT showing grossly abnormal appearances …