Central Skull Base Osteomyelitis with Ischemic Infarct: A Case Report and Literature Review

Skull base osteomyelitis (SBO) defined as an inflammation of bony structures of the cranial base, is rare condition with substantial morbidity and mortality. It typically involves temporal bone and manifested as otologic symptom and cranial neuropathy. Central skull base osteomyelitis (CSBO) is atypical form of SBO that involves the sphenoid and clivus and related to non-otogenic conditions. We present an unusual case of CSBO presented with ischemic stroke and multiple cranial nerve involvement. A diabetic women of 45 years old, with a previous history of right otalgia without otorrhea and severe headache, admitted with sudden left hemiplegia and controlateral multiple cranial nerve (CN) palsies. Cerebral imaging investigations (CT and MRI scans) showed ischemic infraction secondary to the occlusion of the right internal carotid artery (ICA) and radiological evidence of invasive osteomyelitis on the right side of the central skull base with contiguous lateral sinus thrombosis. Broad spectrum antibiotics and anticoagulant therapy was initiated with unfavorable outcome. Based on thorough review of the literature, arterial cerebrovascular complications revealing CSBO are extremely rare and the diagnosis is often challenging for the clinician.