Gradenigo syndrome in children during otitis media is a very rare complication since the use of antibiotics: nevertheless, it must be taken into account in case of otitis media, abducens nerve paralysis and facial pain in regions innervated by the first and second division of trigeminal nerve. We report the case of a 4-year-old boy whose neurological signs and clinical history prompted us to entertain a diagnosis of Gradenigo syndrome, which was not confirmed by CT and MRI findings, revealing otomastoiditis and sinus thrombosis.