PMC5878895_01
The right ear showing a large central eardrum perforation (P).
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The eardrum perforation was large, central in position, and appeared chronic with edges that were scarred (Figure 1).
(a) Deviation of the tongue to the right on its voluntary protrusion as illustrated by the direction of the arrow (right CN XII palsy). (b) After treatment, the patient showing symmetrical protrusion of the tongue as illustrated by the direction of the arrow.
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Together with inputs from a neurologist, it was noted that the patient's tongue deviated to the right on protrusion (CN XII) (Figure 2(a)). Cranial nerve deficits reverted to normal when he was reviewed after 6 weeks of intravenous antibiotics (Figures 2(b) and 3(b)).
(a) Impaired elevation of the right side of the soft palate (R) as compared to the left (L) with reference to the uvula (U) (right CN X palsy). (b) After treatment, symmetrical elevation of the right (R) and left (L) sides of the soft palate with reference to the uvula (U).
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IX), and the elevation of the soft palate on the right side was impaired (CN X) (Figure 3(a)). In addition to the reduced mobility of the right vocal cord (CN X), weakness of right sternocleidomastoid muscle (CN XI) was also observed.
MRI scan (axial cut) of the skull base showing a large lesion involving the region of the right jugular foramen (JF). The sigmoid-jugular venous complex (VC) seen on the left side is not apparent on the right side. The lesion extends laterally beyond the jugular foramen and enhances greater than the nasal mucosa (M), and the Eustachian tubal architecture is relatively preserved (arrow).
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Magnetic resonance imaging (MRI) showed a large mass with central necrosis or suppuration in the right skull base, centering at the right petrous bone and the clivus (Figure 4).