Atypical Base of Skull Osteomyelitis Presenting as Bilateral Facial Palsy

Abstract

Base of skull osteomyelitis is a rare cause of headaches and cranial neuropathies in general, and cranial nerve VII palsy in particular. Both typical and atypical skull base osteomyelitis can have similar presentation and Magnetic Resonance Imaging of the brain is very important to differentiate between them since each is caused by a different organism and requires different treatment. However, bone sampling remains crucial for diagnosis in atypical cases. We hereby report a case of atypical skull base osteomyelitis presenting as bilateral peripheral facial nerve palsy. We also present a new and less invasive diagnostic and therapeutic approach especially when bone sampling is not possible and intravenous empiric treatment cannot be initiated.