1
|
Yoshimura Y, Kanda-Kikuchi J, Hara T, Sugimoto I. Idiopathic hypertrophic pachymeningitis in a patient with a history of diffuse large B cell lymphoma. BMJ Case Rep 2023; 16:e254847. [PMID: 37316284 PMCID: PMC10277052 DOI: 10.1136/bcr-2023-254847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
A man in his early 70s with a 4-year history of diffuse large B cell lymphoma (DLBCL) was admitted to our hospital with diplopia and achromatopsia. Neurological examination revealed visual impairment, ocular motility disorder and diplopia on looking to the left. Blood and cerebrospinal fluid investigations showed no significant findings. MRI revealed diffusely thickened dura mater and contrast-enhanced structures in the left apical orbit, consistent with hypertrophic pachymeningitis (HP). We performed an open dural biopsy to distinguish the diagnosis from lymphoma. The pathological diagnosis was idiopathic HP, and DLBCL recurrence was ruled out. Following methylprednisolone pulse and oral prednisolone therapy, his neurological abnormalities gradually receded. Open dural biopsy played an important role not only in diagnosing idiopathic HP but also in relieving the pressure on the optic nerve.
Collapse
Affiliation(s)
- Yusuke Yoshimura
- Department of Neurology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Junko Kanda-Kikuchi
- Department of Neurology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Takayuki Hara
- Department of Neurosurgery, Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - Izumi Sugimoto
- Department of Neurology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| |
Collapse
|
2
|
López-Simón E, Corriols-Noval P, Castillo-Ledesma N, Rodríguez-Martín M, Morales-Angulo C. Audiovestibular Symptoms in Patients With Idiopathic Hypertrophic Pachymeningitis: Systematic Literature Review. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 72:387-393. [PMID: 34844678 DOI: 10.1016/j.otoeng.2020.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/18/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Hypertrophic pachymeningitis is an infrequent inflammatory disease resulting in thickening and fibrosis of the dura mater. In most cases, the cause in unknown and is called idiopathic hypertrophic pachymeningitis (IHP). Audiovestibular symptoms are infrequent and the pathogenesis is still unclear. MATERIALS AND METHODS A systematic literature review of cases with IHP and vestibular symptoms from 2000 to February 2020 was performed. PRISMA Checklist was followed and PubMED database, Web of Science and Cochrane library were searched. We report a case of an adolescent with a diagnosis of vestibular neuritis in the context of IHP attended in our clinic. RESULTS We reviewed 5 articles related to IHP and vestibular disorders. A total of 7 cases (5 women and 2 men), with ages between 27 and 68 years with IHP were found. They all had audiovestibular symptoms. In contrast to our patient, uni or bilateral neurosensorial hearing loss was reported in all cases. Furthermore, there is no other case report published describing the association between IHP and vestibular neuritis. High dose steroids improved symptoms in 85.7% of the patients. CONCLUSION Vestibular symptoms in IHP are uncommon and the pathogenesis is still debatable. Entrapment of nerves in the internal auditory canal and secondary neuronal damage could be suspected as the main cause of hearing and vestibular loss.
Collapse
Affiliation(s)
- Eugenia López-Simón
- Unidad de Otoneurología, Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), Spain.
| | - Patricia Corriols-Noval
- Unidad de Otoneurología, Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), Spain
| | - Nathalia Castillo-Ledesma
- Unidad de Otoneurología, Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), Spain
| | - Minerva Rodríguez-Martín
- Unidad de Otoneurología, Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), Spain
| | - Carmelo Morales-Angulo
- Unidad de Otoneurología, Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), Spain
| |
Collapse
|
3
|
López-Simón E, Corriols-Noval P, Castillo-Ledesma N, Rodríguez-Martín M, Morales-Angulo C. Audiovestibular symptoms in patients with idiopathic hypertrophic pachymeningitis: Systematic literature review. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 72:S0001-6519(20)30171-0. [PMID: 33648724 DOI: 10.1016/j.otorri.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/15/2020] [Accepted: 08/18/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Hypertrophic pachymeningitis is an infrequent inflammatory disease resulting in thickening and fibrosis of the dura mater. In most cases, the cause in unknown and is called idiopathic hypertrophic pachymeningitis (IHP). Audiovestibular symptoms are infrequent and the pathogenesis is still unclear. MATERIALS AND METHODS A systematic literature review of cases with IHP and vestibular symptoms from 2000 to February 2020 was performed. PRISMA Checklist was followed and PubMED database, Web of Science and Cochrane library were searched. We report a case of an adolescent with a diagnosis of vestibular neuritis in the context of IHP attended in our clinic. RESULTS We reviewed 5 articles related to IHP and vestibular disorders. A total of 7 cases (5 women and 2 men), with ages between 27 and 68 years with IHP were found. They all had audiovestibular symptoms. In contrast to our patient, uni or bilateral neurosensorial hearing loss was reported in all cases. Furthermore, there is no other case report published describing the association between IHP and vestibular neuritis. High dose steroids improved symptoms in 85.7% of the patients. CONCLUSION Vestibular symptoms in IHP are uncommon and the pathogenesis is still debatable. Entrapment of nerves in the internal auditory canal and secondary neuronal damage could be suspected as the main cause of hearing and vestibular loss.
Collapse
Affiliation(s)
- Eugenia López-Simón
- Unidad de Otoneurología, Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España.
| | - Patricia Corriols-Noval
- Unidad de Otoneurología, Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España
| | - Nathalia Castillo-Ledesma
- Unidad de Otoneurología, Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España
| | - Minerva Rodríguez-Martín
- Unidad de Otoneurología, Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España
| | - Carmelo Morales-Angulo
- Unidad de Otoneurología, Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), España
| |
Collapse
|
4
|
Muelleman T, Kavookjian H, Lin J, Staecker H. Hypertrophic Pachymeningitis of the Internal Auditory Canal: A Rare Case of Unilateral Sudden Sensorineural Hearing Loss. Ann Otol Rhinol Laryngol 2018; 127:649-652. [PMID: 29938521 DOI: 10.1177/0003489418784051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To describe and increase awareness of a rare cause of unilateral sudden sensorineural hearing loss. METHODS Case report and literature review. RESULTS We present a 66-year-old female who suffered left-sided sudden sensorineural hearing loss and dizziness. Diagnostic magnetic resonance imaging (MRI) did not reveal masses or lesions along the eighth cranial nerve or in the inner ear. Upon eventual referral to neurotology clinic, hypertrophic pachymeningitis of her left internal auditory canal and adjacent middle and posterior fossa dura were identified. The ensuing laboratory workup for autoimmune and infectious etiology revealed mild elevation of ACE 93 (9-67) but otherwise normal results. CONCLUSIONS Idiopathic hypertrophic pachymeningitis is a diagnosis of exclusion. Neoplastic, infectious, and autoimmune causes must be ruled out. The prevailing treatment for this condition is high-dose corticosteroids. This entity should be considered when evaluating MRI scans obtained in the setting of sudden sensorineural hearing loss.
Collapse
Affiliation(s)
- Thomas Muelleman
- 1 University of Kansas Department of Otolaryngology-Head and Neck Surgery, Kansas City, Kansas, USA
| | - Hannah Kavookjian
- 1 University of Kansas Department of Otolaryngology-Head and Neck Surgery, Kansas City, Kansas, USA
| | - James Lin
- 1 University of Kansas Department of Otolaryngology-Head and Neck Surgery, Kansas City, Kansas, USA
| | - Hinrich Staecker
- 1 University of Kansas Department of Otolaryngology-Head and Neck Surgery, Kansas City, Kansas, USA
| |
Collapse
|
5
|
Dziedzic T, Wojciechowski J, Nowak A, Marchel A. Hypertrophic pachymeningitis. Childs Nerv Syst 2015; 31:1025-31. [PMID: 25771924 DOI: 10.1007/s00381-015-2680-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 03/04/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hypertrophic pachymeningitis (HP) is a rare clinical entity characterized by diffuse or localized fibrous thickening of the dura mater. It is well known but rare especially in pediatric population disease of differing origins. The primary (idiopathic) form is diagnosed after excluding other possible etiologies. Similar results from magnetic resonance imaging (MRI) for patients with hypertrophic pachymeningitis and meningiomas may make the diagnosis confusing. Additionally, making a proper diagnosis without histological sampling can be difficult in some cases. CASE DESCRIPTION We present a case of an 18-year-old boy diagnosed with hypertrophic pachymeningitis in the area of the hypoglossal canal. The diagnosis was made after a 2-month history of hypoglossal nerve palsy and dysphagia preceded by a middle ear infection. The patient was treated surgically with suspicion of meningioma, but no evidence of a tumor was found during the operation. The postoperative period was uneventful. At the latest check-up, MRI revealed regression of all previously observed pathological changes.
Collapse
Affiliation(s)
- Tomasz Dziedzic
- Department of Neurosurgery, Medical University of Warsaw, Banacha 1a, 02-097, Warszawa, Poland,
| | | | | | | |
Collapse
|
6
|
Idiopathic pachymeningitis presenting with progressive sensorineural hearing loss, tinnitus and confusion. Otol Neurotol 2014; 34:e47-8. [PMID: 23739554 DOI: 10.1097/mao.0b013e31828daeb1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
7
|
Reversible Sensorineural Hearing Loss due to Pachymeningitis Associated with Elevated Serum MPO-ANCA. Clin Exp Otorhinolaryngol 2011; 4:155-8. [PMID: 21949583 PMCID: PMC3173708 DOI: 10.3342/ceo.2011.4.3.155] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 10/03/2009] [Indexed: 11/24/2022] Open
Abstract
Hypertrophic pachymeningitis is a progressive disease resulting in a diffuse thickening of dura mater due to inflammation, tumor or autoimmune diseases, but most cases are idiopathic. It is seldom reported to be related to sensorineural hearing loss, but it can cause sensorineural hearing loss which can be potentially reversed through treatment. Here, we report the case of a 54-year-old woman who had progressive, bilateral, worse in the left, sensorineural hearing loss and visual disturbance with an accompanying headache over several months. Brain MRI showed diffusely thickened dura mater, highly enhanced after gadolinium administration, which was consistent with pachymeningitis. It was assumed to be related to autoimmune pathogenesis on the basis of elevated serum myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) titers. After empirical steroid and cyclophosphamide therapy, auditory impairment improved, especially in the high frequency region of the pure tone audiogram, and significant improvement in the word recognition test. Moreover, a follow-up MRI revealed much decreased enhancement of the dura mater, and the MPO-ANCA titer decreased to within the normal range. In the case of rapidly progressive sensorineural hearing loss or hearing impairment accompanying other cranial neuropathy, pachymeningitis should be taken into consideration, and brain MRI with gadolinium enhancement is the best method of detecting it. Also, to ensure proper treatment, a cautious evaluation including an ANCA work-up should be performed.
Collapse
|
8
|
Kawamura S, Sakamoto T, Kashio A, Kakigi A, Ito K, Suzuki M, Yamasoba T. Cochlear implantation in a patient with atypical Cogan's syndrome complicated with hypertrophic cranial pachymeningitis. Auris Nasus Larynx 2010; 37:737-41. [DOI: 10.1016/j.anl.2010.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 04/11/2010] [Accepted: 04/20/2010] [Indexed: 11/29/2022]
|
9
|
Abstract
Autoimmune inner ear disease probably accounts for less than 1% of all cases of balance disorders, but its incidence is often overlooked due to the absence of a specific diagnostic test. Furthermore, in several systemic autoimmune diseases the vestibulo-cochlear system may be affected. Clinical features comprise generalized imbalance, ataxia, motion intolerance, episodic vertigo and positional vertigo. An autoimmune mechanism seems to be responsible for 6% of unilateral and 16% of bilateral forms of Ménière's disease. Oscillopsia and disequilibrium secondary to a bilateral vestibular paresis are probably caused by an autoimmune response in 5% of cases. Balance disorders of central origin may be due to other immuno-mediated disorders such as multiple sclerosis, brainstem encephalitis and vasculitidis. Aim of this paper is to assess the clinical features of autoimmune vertigo disorders through a systematic literature review.
Collapse
|
10
|
Current World Literature. Curr Opin Otolaryngol Head Neck Surg 2008; 16:490-5. [DOI: 10.1097/moo.0b013e3283130f63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|