OBJECTIVE: to describe case of syndrome of Gradenigo, the importance of a diagnosis fast e saves therapeutical immediate. CASE REPORT: PHLS, 2 years, masculine sex, directed for pediatrician with picture of hyaline rhinorrhea, fever, otalgia to the right have 8 days without improvement with use of the amoxicilina. Ahead of the picture, after 4 days of continuous otalgia, child it started to complain of chronic headache, presented vomits, diplopia, high fever, rigidity of nape of the neck, paralysis of 6o cranial pair to the right and pain in the area of innervation of the ophthalmic branch to the right; it did not have phlogistic signals in mastoids. The otoscopy to the left one was normal e, to the right, had only hyperemia of the tympanic membrane. The computerized tomography of skull presented veiling of the mastoid cells bilaterally, with bigger accentuation to the right. The magnetic nuclear resonance of secular bone confirmed the findings of acute mastoidities and disclosed thrombosis of the transversal sinus and sigmoid to the right with signals of partial venous reperfusion. In the internment, venous antibioticotherapy with Ceftriaxone was initiated and was carried through tympanotomy with rank of pipe of bilateral ventilation. In as the day of antibiotic therapy after had regression of the chronic headache and the rigidity of nape of the neck, presenting complete remission of the paralysis of 6th cranial pair 10 days of antibiotic therapy. CONCLUSION: Diagnosis fast e beginning of the treatment is mandatory in the cases of complicated acute average otitides. The behavior conservative with antibiotic therapy and rank of Pipe of ventilation without mastoidectomy demonstrates that the treatment most aggressive is private for patients with refractory picture to the therapy conservative or that they demonstrate signals of chronic process.