External ophtalmoplegia secondary to apical petrositis: Gradenigo´s syndrome

Unilateral facial pain in the trigeminal sensitive area and unilateral abducens paralysis (VI cranial nerve) are the main clinical features of Gradenigo´s syndrome, due to apical petrositis as secondary intracranial involvement during an acute episode of purulent otitis media. Very common in the preantibiotics era, nowadays very unusual although a high index of clinical suspicion is important when facing a child with acute otitis media and signs of brain involvement, in order to start promptly medical treatment to avoid the surgical treatment, often needed in the late diagnosed cases.