LOCALIZED BULBAR CISTERNA (PONTILE) MENINGITIS, FACIAL PAIN AND SIXTH NERVE PARALYSIS AND THEIR RELATION TO CARIES OF THE PETROUS APEX

Abstract

I. FACIAL PAIN Gradenigo syndrome of sixth nerve paralysis, associated with fifth nerve pain and a discharging ear, has been the subject of numerous communications, the general trend of which would give the impression that the abductor paralysis results from pressure on the nerve either ( a ) by the petrosphenoidal (Gruber's) ligament as the nerve passes over the petrous apex secondary to swelling of the bone of the petrous apex or ( b ) it is the manifestation of a localized meningitis in the neighborhood of the nerve. In a few cases sixth nerve paralysis has been regarded as resulting from ( c ) neuritis of toxic origin. The prognosis is generally regarded as favorable. All authors advocate the prompt opening of the mastoid when the neurologic symptoms appear early in the course of an otitis; while in the cases in which the syndrome develops subsequent to the operation, delay in further operating is advocated,