Unilateral left lateral rectus palsy: A rare complication of acute otitis media

Petrous apicitis is an extension of infection from mastoid air cells into the petrous apex. The infection may also spread outside the petrous apex to affect the meninges causing meningitis, cranial nerve palsies, encephalitis, brain abscess, cavernous sinus thrombosis, and even death; however, these complications are rare. Only a few patients with petrous apicitis exhibit the complete triad described by Gradenigo comprising retro-orbital pain, sixth nerve palsy, and otorrhea. We present a rare case of petrositis with pachymeningitis with unilateral abducens nerve palsy following acute suppurative otitis media, which was successfully managed medically.