Gradenigo syndrome is a rare condition consisting of otitis media, trigeminal neuralgia and abducens palsy. We report here a 6-year-old girl with this syndrome. Cranial magnetic resonance imaging (MRI) demonstrated inflammatory lesions in the left petrous apex and cavernous sinus, as well as stenosis of the left carotid artery. She was conservatively treated with antibiotics, which successfully improved her clinical and MRI findings. Surgical treatment including mastoidectomy was avoided. This case illustrates the usefulness of MRI in the diagnosis and management of Gradenigo syndrome.