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Samah Y, Sahar B, Mebrouk Y. Clinical, Radiological, and Etiological Aspects of Pachymeningitis: A Study of 24 Cases. Cureus 2024; 16:e61988. [PMID: 38984004 PMCID: PMC11231805 DOI: 10.7759/cureus.61988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2024] [Indexed: 07/11/2024] Open
Abstract
Introduction and importance Hypertrophic pachymeningitis (HP) is an uncommon disorder with varied etiological origins and heterogeneous clinical presentation. Establishing the etiological diagnosis poses a challenge, but prompt identification provides a treatment window, potentially leading to a reversal of symptoms. MRI is the reference examination, allowing not only the early diagnosis of pachymeningitis but also the assessment of its extent and importance, detection of possible complications, and suggestion of etiology. Case presentation We conducted a retrospective study involving 24 patients recruited over 5 years for who brain imaging had revealed the presence of pachymeningitis. The average age of the patients was 40 years, with a male-to-female ratio of 0.6. Clinical discussion Headache was present in 54.17% of patients. All the patients underwent MRI examinations utilizing different sequences, with subsequent Gadolinium injection showing localized and asymmetrical meningeal thickening in 13 cases, and diffuse in the rest. The cerebrospinal fluid study unveiled an inflammatory fluid characterized by a lymphocytic predominance and hyperproteinorrhea, noted in 50% of the patients. The histopathological analysis of a stereotactic biopsy conducted on an individual patient revealed non-diagnostic results. The etiological investigation was dominated by tuberculosis, which was detected in 33.3% of cases. Idiopathic origin was identified in 16.7% of patients. Conclusion Meningeal thickening is rare, and the multitude of potential causes makes the etiological investigation challenging unless they fall within the scope of secondary meningeal disorders; otherwise, a dural biopsy becomes necessary, and the prompt initiation of treatment, along with determining the etiology influences the prognosis.
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Affiliation(s)
- Yousfi Samah
- Department of Neurology, Mohamed VI University Hospital, Mohamed First University, Faculty of Medicine, Oujda, MAR
| | - Boulehoual Sahar
- Department of Neurology, Mohamed VI University Hospital, Mohamed First University, Faculty of Medicine, Oujda, MAR
| | - Yassine Mebrouk
- Department of Neurology, Mohamed VI University Hospital, Mohamed First University, Faculty of Medicine, Oujda, MAR
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Maliha M, Roksana Z, Babli SA, Chowdhury K, West D. The Relationship Between Exacerbation of Pachymeningitis and Chemotherapy: A Case Report. Cureus 2022; 14:e25792. [PMID: 35812596 PMCID: PMC9270911 DOI: 10.7759/cureus.25792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 11/30/2022] Open
Abstract
Pachymeningitis is a rare disorder that involves the dura mater of the cranial and spinal nerves. It can lead to localized or diffuse thickening of the dura mater as an inflammatory reaction. Very little is known about this uncommon disease, and even less is known about its exacerbating factors and relationship with chemotherapy. In this report, we present a case of an 86-year-old man with metastatic bladder carcinoma on chemotherapy who experienced worsening pachymeningitis with symptoms such as headache, aphasia, weakness, and seizures. The patient responded well to steroids, and his symptoms improved. This association between exacerbation of pachymeningitis and chemotherapy is rarely encountered, and its mechanism of action is poorly understood. We hope this case report will add to the existing literature on this uncommon phenomenon and its exacerbating factors.
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Cordeiro NL, Gupta SS, Kanwar A, Bendor-Grynbaum C, Sharma JB. Tuberculous Hypertrophic Pachymeningitis. Cureus 2021; 13:e17570. [PMID: 34513529 PMCID: PMC8405376 DOI: 10.7759/cureus.17570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 08/12/2021] [Indexed: 11/12/2022] Open
Abstract
Tuberculous pachymeningitis is a rare disease that should be suspected in patients with chronic headaches, focal neurological signs, and magnetic resonance imaging (MRI) findings of dural thickening. We report the case of a 62-year-old male who presented with chronic headaches for over a year, progressive right-sided vision and hearing loss for six months, and progressive dysphagia for a month. On investigation, MRI showed dural thickening, cerebrospinal fluid showed lymphocytic pleocytosis with high protein and normal glucose levels, and biopsy of the dural matter showed necrotizing granulomas with Langhans giant cells. The patient responded well to antitubercular treatment and steroids. Follow-up MRI 24 months later showed almost complete resolution of meningeal enhancement. Though tuberculosis is an uncommon cause of pachymeningitis, it should be considered, as it responds well to treatment.
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Affiliation(s)
| | | | - Anubhav Kanwar
- Infectious Disease, Tri-State Memorial Hospital, Clarkston, USA
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Levine A, Vanderah TW, Largent-Milnes TM. An underrepresented majority: A systematic review utilizing allodynic criteria to examine the present scarcity of discrete animal models for episodic migraine. Cephalalgia 2021; 41:404-416. [PMID: 33131303 PMCID: PMC10443224 DOI: 10.1177/0333102420966984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Despite increasing evidence differentiating episodic and chronic migraine, little work has determined how currently utilized animal models of migraine best represent each distinct disease state. AIM In this review, we seek to characterize accepted preclinical models of migraine-like headache by their ability to recapitulate the clinical allodynic features of either episodic or chronic migraine. METHODS From a search of the Pu bMed database for "animal models of migraine", "headache models" and "preclinical migraine", we identified approximately 80 recent (within the past 20 years) publications that utilized one of 10 different models for migraine research. Models reviewed fit into one of the following categories: Dural KCl application, direct electrical stimulation, nitroglycerin administration, inflammatory soup injection, CGRP injection, medication overuse, monogenic animals, post-traumatic headache, specific channel activation, and hormone manipulation. Recapitulation of clinical features including cephalic and extracephalic hypersensitivity were evaluated for each and compared. DISCUSSION Episodic migraineurs comprise over half of the migraine population, yet the vast majority of current animal models of migraine appear to best represent chronic migraine states. While some of these models can be modified to reflect episodic migraine, there remains a need for non-invasive, validated models of episodic migraine to enhance the clinical translation of migraine research.
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Affiliation(s)
- Aidan Levine
- Department of Pharmacology, University of Arizona, Tucson, AZ, 85724, USA
| | - Todd W Vanderah
- Department of Pharmacology, University of Arizona, Tucson, AZ, 85724, USA
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Abrantes FF, Moraes MPMD, Rezende Filho FM, Pedroso JL, Barsottini OGP. A clinical approach to hypertrophic pachymeningitis. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:797-804. [PMID: 33295420 DOI: 10.1590/0004-282x20200073] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 05/14/2020] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Hypertrophic pachymeningitis (HP) is a non-usual manifestation of rheumatologic, infectious, and neoplastic diseases. Etiological diagnosis is a challenge, but when made promptly it creates a window of opportunity for treatment, with the possibility of a total reversal of symptoms. OBSERVATIONS HP is an inflammatory process of the dura mater that can occur as a manifestation of sarcoidosis, granulomatosis with polyangiitis, and IgG4-related disease. The HP case evaluation is extensive and includes central nervous system imaging, cerebrospinal fluid analysis, serology, rheumatologic tests, and systemic survey for other manifestations sites. After systemic investigation, meningeal biopsy might be necessary. Etiology guides HP treatment, and autoimmune disorders are treated with corticosteroids alone or associated with an immunosuppressor. CONCLUSION HP is a manifestation of several diseases, and a precise etiological diagnosis is crucial because of the difference among treatments. An extensive investigation of patients with HP helps early diagnosis and correct treatment.
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Affiliation(s)
- Fabiano Ferreira Abrantes
- Universidade Federal de São Paulo, Divisão de Neurologia Geral, Departamento de Neurologia, São Paulo SP, Brazil
| | | | - Flávio Moura Rezende Filho
- Universidade Federal de São Paulo, Divisão de Neurologia Geral, Departamento de Neurologia, São Paulo SP, Brazil
| | - José Luiz Pedroso
- Universidade Federal de São Paulo, Divisão de Neurologia Geral, Departamento de Neurologia, São Paulo SP, Brazil
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Urbain F, Labeyrie C, Herbrecht A, Nasser G, Cauquil C, Adam C, Lambotte O, Goujard C, Adams D, Noel N. [Cervical spinal sarcoidosis mimicking compressive cervical myelopathy: Poor prognosis after surgery]. Rev Med Interne 2019; 41:78-88. [PMID: 31836247 DOI: 10.1016/j.revmed.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 10/25/2019] [Accepted: 11/17/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Cervical spinal sarcoidosis can mimic compressive cervical myelopathy leading to potentially harmful surgical procedures before the diagnosis can be made. METHODS Retrospective description of 3 patients and review of the literature. RESULTS Twenty-seven patients (16 men/11 women), median age 58 years [range 29-74] were described. Neurosurgical procedures consisted of laminectomy (n=10), laminoplasty (n=15) and anterior discectomy (n=2). Immediately after surgery, 17 patients (63%) worsened or remained disabled. Among the 10 patients who improved, 9 worsened secondarily. The analysis of preoperative MRI showed T2 hypersignal lesions and contrast enhancement in all patients. Neurological symptoms were inaugural in 25/27 patients, and systemic involvement of the sarcoidosis was found after surgery in 15/27 patients. After surgery, all patients received corticosteroids, along with immunosuppressive therapy in 8 cases/27. After a follow-up of 24 [16-72] months; 13 patients were stabilized or worsened, 7 were partially improved. Three died of other cause. Only 5 recovered without sequelae. CONCLUSION In patients with compressive cervical myelopathy, leptomeningeal contrast enhancement, a T2-weighted hypersignal exceeding the compression level on MRI, and the presence of extraneurological symptoms should point to inflammatory disease. These rare manifestations may be the first symptoms of sarcoidosis and should be recognized to avoid harmful surgical procedures and to provide appropriate medical treatment.
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Affiliation(s)
- F Urbain
- Service de médecine interne et immunologie clinique, groupe hospitalier universitaire Paris Sud, hôpital Bicêtre, Assistance publique-hôpitaux de Paris, 94275 Le Kremlin-Bicêtre cedex, France
| | - C Labeyrie
- Service de neurologie, groupe hospitalier universitaire Paris Sud, hôpital Bicêtre, Assistance publique-hôpitaux de Paris, 94275 Le Kremlin-Bicêtre cedex, France; Groupe hospitalier universitaire Paris Sud, centre de référence neuropathies amyloïdes familiales et autres neuropathies rares (NNERF), hôpital Bicêtre, 94275 Le Kremlin-Bicêtre cedex, France
| | - A Herbrecht
- Service de neurochirurgie, groupe hospitalier universitaire Paris Sud, hôpital Bicêtre, Assistance publique-hôpitaux de Paris, 94275 Le Kremlin-Bicêtre cedex, France
| | - G Nasser
- Service de neuroradiologie, groupe hospitalier universitaire Paris Sud, hôpital Bicêtre, Assistance publique-hôpitaux de Paris, 94275 Le Kremlin-Bicêtre cedex, France
| | - C Cauquil
- Service de neurologie, groupe hospitalier universitaire Paris Sud, hôpital Bicêtre, Assistance publique-hôpitaux de Paris, 94275 Le Kremlin-Bicêtre cedex, France; Groupe hospitalier universitaire Paris Sud, centre de référence neuropathies amyloïdes familiales et autres neuropathies rares (NNERF), hôpital Bicêtre, 94275 Le Kremlin-Bicêtre cedex, France
| | - C Adam
- Service d'anatomie pathologique et neuropathologie, groupe hospitalier universitaire Paris Sud, hôpital Bicêtre, Assistance publique-hôpitaux de Paris, 94275 Le Kremlin-Bicêtre cedex, France
| | - O Lambotte
- Service de médecine interne et immunologie clinique, groupe hospitalier universitaire Paris Sud, hôpital Bicêtre, Assistance publique-hôpitaux de Paris, 94275 Le Kremlin-Bicêtre cedex, France; Faculté de médecine, université Paris Sud, 94275 Le Kremlin-Bicêtre, France; Inserm UMR 1184, immunologie des maladies virales et auto-immunes (IMVA), université Paris Sud, 94275 Le Kremlin-Bicêtre cedex, France; CEA, DSV/iMETI, division of immuno-virology, IDMIT, université Paris Sud, 94275 Le Kremlin-Bicêtre cedex, France
| | - C Goujard
- Service de médecine interne et immunologie clinique, groupe hospitalier universitaire Paris Sud, hôpital Bicêtre, Assistance publique-hôpitaux de Paris, 94275 Le Kremlin-Bicêtre cedex, France; Faculté de médecine, université Paris Sud, 94275 Le Kremlin-Bicêtre, France
| | - D Adams
- Service de neurologie, groupe hospitalier universitaire Paris Sud, hôpital Bicêtre, Assistance publique-hôpitaux de Paris, 94275 Le Kremlin-Bicêtre cedex, France; Groupe hospitalier universitaire Paris Sud, centre de référence neuropathies amyloïdes familiales et autres neuropathies rares (NNERF), hôpital Bicêtre, 94275 Le Kremlin-Bicêtre cedex, France; Faculté de médecine, université Paris Sud, 94275 Le Kremlin-Bicêtre, France
| | - N Noel
- Service de médecine interne et immunologie clinique, groupe hospitalier universitaire Paris Sud, hôpital Bicêtre, Assistance publique-hôpitaux de Paris, 94275 Le Kremlin-Bicêtre cedex, France; Faculté de médecine, université Paris Sud, 94275 Le Kremlin-Bicêtre, France; Inserm UMR 1184, immunologie des maladies virales et auto-immunes (IMVA), université Paris Sud, 94275 Le Kremlin-Bicêtre cedex, France; CEA, DSV/iMETI, division of immuno-virology, IDMIT, université Paris Sud, 94275 Le Kremlin-Bicêtre cedex, France.
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Salvador Nunes L, Bart PA, Dunet V, Lu H. [Hypertrophic pachymeningitis revealing metastatic invasive lobular breast carcinoma]. Presse Med 2019; 48:1184-1187. [PMID: 31653539 DOI: 10.1016/j.lpm.2019.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/14/2019] [Accepted: 09/09/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Luis Salvador Nunes
- Centre hospitalier universitaire vaudois, service de médecine interne, rue du Bugnon 46, 1011 Lausanne, Suisse
| | - Pierre-Alexandre Bart
- Centre hospitalier universitaire vaudois, service de médecine interne, rue du Bugnon 46, 1011 Lausanne, Suisse
| | - Vincent Dunet
- Centre hospitalier universitaire vaudois, service de radiodiagnostic et radiologie interventionnelle, Rue du Bugnon 46, 1011 Lausanne, Suisse
| | - Henri Lu
- Centre hospitalier universitaire vaudois, service de médecine interne, rue du Bugnon 46, 1011 Lausanne, Suisse.
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