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Yao S, Liu Y, Sun Q, Qi L, Liu X. A Case of MPO-ANCA-Positive Hypertrophic Cranial Pachymeningitis with Spinal Dura Mater Involvement and Cranial Venous Sinus Thrombosis. Neurol India 2023; 71:807-809. [PMID: 37635533 DOI: 10.4103/0028-3886.383833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- Shengjun Yao
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Yingchao Liu
- Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Qinjian Sun
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Lianping Qi
- Department of Neurology, The People Hospital of Huaiyin Jinan, Jinan, China
| | - Xiaohui Liu
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
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Xiao X, Fu D, Feng L. Hypertrophic Pachymeningitis in a Southern Chinese Population: A Retrospective Study. Front Neurol 2020; 11:565088. [PMID: 33281701 PMCID: PMC7705170 DOI: 10.3389/fneur.2020.565088] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/07/2020] [Indexed: 11/13/2022] Open
Abstract
Aims: To investigate the causes, clinical characteristics, imaging features, and therapeutic implications of hypertrophic pachymeningitis (HP) in a southern Chinese population. Methods: We retrospectively analyzed 48 patients with HP with different causes from 1 January 2006 to 31 December 2018. Clinical manifestation, laboratory findings, and neuroimaging results were evaluated in all HP patients. Results: The mean age at onset was 50 ± 12 years. The most common diagnosis was idiopathic HP (67%), followed by antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (15%), tuberculous meningitis (8%), viral meningitis (6%), and bacterial meningitis (4%). Headache was the most common symptom. The most frequently changed laboratory finding was elevated erythrocyte sedimentation rate (ESR). Imaging was characterized by cerebral or spinal dura mater enhancement in MRI scan with contrast. Enhancements were mainly located in the posterior fossa for idiopathic HP; frontal, parietal, and occipital lobes for ANCA-related HP; and posterior fossa for tuberculous-associated HP. Diffuse enhancement was found in most cases, except for tuberculous-associated HP. Glucocorticoid or immunosuppressive treatment was applied in most cases. Conclusions: The etiology of HP varied among patients, with idiopathic HP being the most common. MRI showed enhancement of the dura mater, which differed according to different etiologies. Glucocorticoid or immunosuppressive agents were the primary drugs for treatment.
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Affiliation(s)
- Xuewen Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Dongni Fu
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
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Kutty R, Sreemathyamma S, Sivanandapanicker J, Peethambaran A. Idiopathic Hypertrophic Spinal Pachymeningitis: A Rare Cause of Spinal Cord Compression. Neurol India 2019; 67:1380-1385. [DOI: 10.4103/0028-3886.271262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bang JH, Cho KT, Kim EJ. Idiopathic Hypertrophic Pachymeningitis in the Craniocervical Junction. KOREAN JOURNAL OF SPINE 2015; 12:169-72. [PMID: 26512276 PMCID: PMC4623176 DOI: 10.14245/kjs.2015.12.3.169] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 08/21/2015] [Accepted: 09/02/2015] [Indexed: 11/27/2022]
Abstract
Idiopathic hypertrophic pachymeningitis (IHP) is a rare disease, and it is characterized by chronic progressive inflammatory fibrosis and thickening of the dura mater with resultant compression of the spinal cord or neural structure without any identifiable cause. It can occur in the intracranial or spinal dura mater alone or as a craniospinal form. The spinal form is rarer than the cranial form and the craniospinal form is extremely rare. We report a rare case of IHP in the craniocervical junction involving both the cranial and spinal dura mater and discuss the diagnosis and management of the disease.
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Affiliation(s)
- Jin Hyuk Bang
- Department of Neurosurgery, Dongguk University Ilsan Hospital, Goyang, Korea and Dongguk University, Seoul, Korea
| | - Keun-Tae Cho
- Department of Neurosurgery, Dongguk University Ilsan Hospital, Goyang, Korea and Dongguk University, Seoul, Korea
| | - Eo Jin Kim
- Department of Pathology, Dongguk University Ilsan Hospital, Goyang, Korea and Dongguk University, Seoul, Korea
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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.
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Affiliation(s)
- Tomasz Dziedzic
- Department of Neurosurgery, Medical University of Warsaw, Banacha 1a, 02-097, Warszawa, Poland,
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Subrati N, Vaqas B, Peterson D, Patel MC. Hypertrophic pachymeningitis with sarcoidosis: a rare cause of craniocervical compression. BMJ Case Rep 2015; 2015:bcr-2014-208604. [PMID: 26021381 DOI: 10.1136/bcr-2014-208604] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe a case of a 58-year-old woman with a suspected dural tumour. She presented with progressive pyramidal weakness. MRI confirmed compression of the medulla oblongata and spinal cord at the level of C1-3. The localised dural mass lesion homogenously enhanced on T1 MRI and was considered most likely to be a meningioma. Incidentally, CT scan of the chest revealed peribronchial soft tissue thickening, suggestive of pulmonary sarcoidosis. Owing to the progressive nature of her weakness, she had a posterior occipitocervical decompression with a C1-3 laminectomy and resection of the thickened dura. Histology showed densely collagenous tissue with scanty psammoma bodies and multinucleate giant cells, consistent with hypertrophic pachymeningitis (HP)-a rare, chronic inflammatory condition, characterised by thickening and fibrosis of the dura. This case demonstrates that masses in the craniocervical junction can be varied in pathology and when there is evidence of systemic inflammation, HP should be considered.
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Affiliation(s)
- Nagina Subrati
- Department of Neurosurgery, Kings College Hospital, London, UK
| | - Babar Vaqas
- Department of Neurosurgery, Charing Cross Hospital, London, UK
| | - David Peterson
- Department of Neurosurgery, Charing Cross Hospital, London, UK
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Zhu R, He Z, Ren Y. Idiopathic hypertrophic craniocervical pachymeningitis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24 Suppl 4:S633-5. [PMID: 25893340 DOI: 10.1007/s00586-015-3956-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 04/12/2015] [Accepted: 04/12/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Hypertrophic craniocervical pachymeningitis (HCP) is a rare disease causing chronic inflammatory hypertrophy of the cranial and spinal dura mater. To increase awareness of this condition, we report the details of a case here. METHODS We reviewed the case of a 78-year-old man presenting with a rare case of HCP and summarized the clinical features, laboratory evaluations and treatment of the case. RESULTS In this case, the HCP involved the intracranial dura and high cervical regions, manifesting as lower cranial nerve palsies, headache, and neck pain, developing over 7 months. Magnetic resonance imaging revealed thickening of the dura in the craniocervical region with peripheral enhancement. Steroid therapy was commenced and the symptoms improved rapidly. CONCLUSIONS HCP can be diagnosed by MRI and laboratory investigations. In this case corticosteroid treatment was effective, although care must be taken when slowly reducing the dose. This case highlights HCP as a cause of progressive cerebellomedullar and cervical spinal cord symptoms.
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Affiliation(s)
- Ruixia Zhu
- Department of Neurology, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110001, China
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Sánchez Medina Y, Triana Pérez A, Domínguez Baez J, Gómez Perals LF, Pérez del Rosario PA. [Chronic hypertrophic pachymeningitis: 2 clinical cases are presented]. Neurocirugia (Astur) 2012. [PMID: 23206857 DOI: 10.1016/j.neucir.2011.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Chronic hypertrophic pachymeningitis is an inflammatory process of unknown aetiology characterised by a thickening of the dura mater causing pseudotumoural growth. Clinical manifestations are usually secondary to compression of adjacent neurological structures but may be also secondary to inflammatory processes. Diagnosis is mainly obtained by excluding infectious, neoplastic and autoimmune causes. Nowadays, steroid treatment is the most commonly used therapy. Two clinical cases of hypertrophic pachymeningitis are presented which were treated by surgery without any additional treatment and with good clinical and radiological development.
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Affiliation(s)
- Yanire Sánchez Medina
- Servicio de Neurocirugía, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz, Tenerife, España.
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Elverland HH. From ear to brain. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:1357. [PMID: 22717863 DOI: 10.4045/tidsskr.12.0382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Hans H Elverland
- Ear, Nose and Throat Section, Nordland Hospital Lofoten, Leknes, Norway.
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Servioli MJ, Chugh C, Lee JM, Biller J. Rheumatoid meningitis. Front Neurol 2011; 2:84. [PMID: 22275906 PMCID: PMC3250627 DOI: 10.3389/fneur.2011.00084] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 12/02/2011] [Indexed: 11/27/2022] Open
Abstract
An 80-year-old woman with rheumatoid arthritis had gait difficulties and frequent falls. MRI of the brain showed an extra-axial enhancing lesion overlying the right frontal–parietal cortex, that progressively extended to the contralateral side. This was accompanied by further decline in her functional status. We discuss the diagnostic and therapeutic approach of a pachy–leptomeningeal process in a rheumatoid patient.
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Affiliation(s)
- María J Servioli
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago Chicago, IL, USA
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Yunokawa K, Hagiyama Y, Mochizuki Y, Tanaka N, Ochi M. Hypertrophic spinal pachymeningitis associated with heavy-chain disease. Case report. J Neurosurg Spine 2007; 7:459-62. [PMID: 17933324 DOI: 10.3171/spi-07/10/459] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors present a case of concurrent hypertrophic spinal pachymeningitis (HSP) and heavy-chain disease (HCD). The patient was a 71-year-old woman presenting with leg paralysis and fever. Laminectomy was performed for thoracic HSP, and chemotherapy was administered for HCD. Because the dura mater was not surgically opened, marked hypertrophy remained postoperatively. Once the HCD was controlled by chemotherapy, the fever subsided and the hypertrophy was resolved. No previous reports have supported a link between the two diseases. Idiopathic HSP may be secondary to rare conditions such as HCD, and systemic examinations should be performed to the fullest extent possible to investigate the possibility of some underlying disease.
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Affiliation(s)
- Kazuki Yunokawa
- Department of Orthopedic Surgery, Matsuyama City Hospital, Matsuyama City, Japan.
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Bravo D, Machová H, Hahn A, Marková H, Otruba L, Mandys V, Houstava L, Kalvach P. Mastoiditis complicated with Gradenigo syndrome and a hypertrophic pachymeningitis with consequent communicating hydrocephalus. Acta Otolaryngol 2007; 127:93-7. [PMID: 17364337 DOI: 10.1080/00016480500475583] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We present the clinical, radiological and pathological features of a case of a cranial hypertrophic pachymeningitis that developed in the course of mastoiditis and petrous apex inflammation and responded to immunosuppressive therapy only. Documented by the development of clinical findings, magnetic resonance imaging, cerebrospinal fluid changes, histopathology findings, by otosurgical intervention and finally by the insertion of a ventriculo-peritoneal shunt, the case illustrates a gradual development of pachymeningitis with consequent hydrocephalus and intracranial hypertension. We consider this disease development an example of immune-induced proliferative fibrotic changes in meninges.
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Affiliation(s)
- Dina Bravo
- Department of Neurology, Charles University, 3rd Medical Faculty and Faculty Hospital Královské Vinohrady, Prague, Czech Republic.
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Ruiz-Sandoval JL, Bernard-Medina G, Ramos-Gómez EJ, Romero-Vargas S, Gutiérrez-Ureña S, González-Cornejo S, Chiquete E. Idiopathic hypertrophic cranial pachymeningitis successfully treated with weekly subcutaneous methotrexate. Acta Neurochir (Wien) 2006; 148:1011-4. [PMID: 16614804 DOI: 10.1007/s00701-006-0775-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2005] [Accepted: 02/26/2006] [Indexed: 11/30/2022]
Abstract
Idiopathic hypertrophic cranial pachymeningitis is a very infrequent disorder. Adequate management is still a matter of debate. We describe the use of low-dose pulse methotrexate in treating a 63-year-old woman with idiopathic hypertrophic cranial pachymeningitis. A weekly scheme with subcutaneous methotrexate was tried. Clinical improvement occurred in one week. Total remission of the clinical and neuro-imaging abnormalities was evident 6 months later, with minimal side effects. The patient is in complete remission after one year of follow-up without treatment. Hence, low-dose weekly subcutaneous methotrexate may be safe and effective in inducing complete and sustained remission of this condition. The experience with subcutaneous methotrexate to treat this entity has never been reported.
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Affiliation(s)
- J L Ruiz-Sandoval
- Department of Neurology and Neurosurgery, Hospital Civil "Fray Antonio Alcalde", Universidad de Guadalajara, Guadalajara Jalisco, México.
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Kuhn J, Harzheim A, Riku S, Müller W, Bewermeyer H. [Hypertrophic cranial pachymeningitis as a rare cause of headache]. DER NERVENARZT 2005; 77:423-9. [PMID: 16283149 DOI: 10.1007/s00115-005-2012-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hypertrophic cranial pachymeningitis is an uncommon, fibrosing, inflammatory process that involves the dura mater. The condition is being reported more frequently owing to the use of cranial MRI. The main clinical feature is headache, whereas cranial nerve lesions, cerebellar symptoms, and epileptic seizures occur more rarely. A variety of autoimmune and infectious diseases can result in this condition, which is labeled as idiopathic in the absence of any definite inciting factor. The diagnosis of hypertrophic cranial pachymeningitis is based on neuroimaging of thickened and enhancing dura mater. It can be defined pathologically on biopsy. A specific treatment is indicated in some cases of secondary hypertrophic cranial pachymeningitis. Mostly, treatment relies on corticosteroids and immunosuppressive agents. This review summarizes the current knowledge on causes, clinical presentation, diagnosis, and treatment of this disorder.
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Affiliation(s)
- J Kuhn
- Neurologische Klinik, Krankenhaus Merheim, Kliniken der Stadt Köln gGmbH.
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Abstract
Idiopathic hypertrophic pachymeningitis is a rare disorder of unknown origin. It is a fibrosing inflammatory process that involves the dura mater. Herein are described 14 patients with idiopathic hypertrophic pachymeningitis; their clinical, laboratory and radiological findings, as well as their treatment, are analyzed. Neuropathological findings of six cases including two autopsied cases are also presented. The main clinical features were headache and cranial nerve palsies. Many patients had mild to moderate elevation of C-reactive protein, and three patients had perinuclear antineutrophil cytoplasmic antibody. The CSF in most cases showed inflammatory changes. Neuroimaging studies revealed diffuse or localized thickening of the dura, and MRI findings were key to diagnosis of this disorder. The clinical course was chronic. All patients were treated with corticosteroid and improved intially, but half of them experienced relapses. Two patients received surgical intervention. Pathological examination in two autopsied cases revealed diffuse thickening of the dura, especially in the posterior part of the falx cerebri and the tentorium cerebelli. Microscopic examination of the dura showed dense fibrosis with inflammatory cell infiltration composed mainly of lymphocytes. The cell infiltration was marked at the surface of the dura mater. One case had necrotizing vasculitis of the small arteries located in the dura and the cerebral surface. There were no giant cells, caseation necrosis, or epitheloid granuloma. Four patients underwent biopsy of the dura, and the pathological study showed non-specific inflammatory changes. The relationship of idiopathic hypertrophic pachymeningitis with connective tissue disease or vasculitis syndrome is discussed.
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Affiliation(s)
- Shigeo Riku
- Department of Neurology, Social Insurance Chukyo Hospital, Minami, Nagoya, Japan.
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Esparcia Navarro A, Roig Rico P, Mínguez Vera M, Botella Asunción C. Paquimeningitis crónica hipertrófica idiopática. Aportación de dos nuevos casos y revisión de la literatura. Rev Clin Esp 2003. [DOI: 10.1016/s0014-2565(03)71268-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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