Case Of Hypertrophic Cranial Pachymeningitis Research Articles

Hypertrophic Cranial Pachymeningitis Induced by Long-Term Administration of Nonsteroidal Antiinflammatory Drugs

To report a case of hypertrophic cranial pachymeningitis (HCP) associated with the long-term administration of nonsteroidal antiinflammatory drugs (NSAIDs). A 23-year-old man presented with recurrent headaches as the primary clinical manifestation. After the administration of the NSAIDs indomethacin and aceclofenac for 2 years, he developed signs of progressive cranial polyneuropathies (eg, II, III, V, VI, and VII palsy) and damage to the brainstem. Cranial contrast-enhanced magnetic resonance imaging (MRI) revealed curvilinear subdural enhancement and significant tentorium cerebelli and falx cerebri enhancements. Since antituberculosis treatment combined with corticosteroid therapy and analgesia with celecoxib for 40 days had not achieved satisfactory results, NSAIDs were discontinued and a single oral dose of a corticosteroid was given. No headaches were reported at a 6-month follow-up appointment. In addition, his cranial polyneuropathy improved significantly. Reexamination by contrast-enhanced MRI scan demonstrated that tentorial enhancement and thickening of the falx cerebri were markedly alleviated. No additional causes of HCP were found during systematic investigation in this patient. In addition to headache, cranial polyneuropathy and thickened cerebral dura mater appeared after administration of NSAIDs for 2 years. The symptoms that appeared during the NSAID therapy were remarkably alleviated 5 months after medication discontinuation. Adverse drug reaction (ADR) assessment revealed that long-term administration of NSAIDs may be associated with the occurrence and development of HCP. Long-term administration of NSAIDs is a probable cause of HCP. Clinicians should be aware of this ADR and avoid prescribing NSAIDs for an extended period.

MPO-ANCA-positive Wegener?s granulomatosis presenting with hypertrophic cranial pachymeningitis: case report and review of the literature

We describe a case of hypertrophic cranial pachymeningitis (HCP) associated with Wegener's granulomatosis (WG) in a 60-year-old man presenting with chronic headache and multiple cranial nerve neuropathies. A test for antibodies to the neutrophil cytoplasmic protein myeloperoxidase (MPO-ANCA) was positive in this case. We review the literature on perinuclear (p)-ANCA-related HCP, including our case. This case indicates the link between MPO-ANCA-positive WG and HCP.

Idiopathic hypertrophic cranial pachymeningitis associated with Sweet's Syndrome

A case of hypertrophic cranial pachymeningitis associated with Sweet's Syndrome is presented. Both entities have been described in association with several other chronic systemic inflammatory diseases and autoimmune conditions. To our knowledge the coexistence between Sweet's Syndrome and hypertrophic cranial pachymeningitis has not been reported up to date. We suggest a possible autoimmune or dysimmune mechanism in the pathogenesis of these two entities.

特異的画像所見を呈した大脳鎌肥厚性硬膜炎の1例

特異的画像所見を呈した大脳鎌肥厚性硬膜炎の1例

Hypertrophic cranial pachymeningitis involving dural sinuses: a pseudo signal-void appearance on MRI

A case of hypertrophic cranial pachymeningitis with an unusual and misleading manifestation is reported. CT detected calcified tentorium and superior sagittal sinus. MR imaging and MR angiography depicted tentorial thickening as well as occlusion of all major dural sinuses. Fibrocalcific occlusion of dural sinuses showed interestingly signal-void appearance on spin-echo images which could readily be interpreted as being patent sinuses.

Hypertrophic cranial pachymeningitis involving the pituitary gland: A case report

As the use of magnetic resonance imaging (MRI) has become widespread, the reported cases of pachymeningitis have increased. Various inflammations are known to occur in the pituitary gland. However, an association between pachymeningitis and pituitary inflammation has not been recognized previously. This 56-year-old woman complained of incessant headache and deafness. MRI showed thickened dura at the right convexity and a dumbbell shaped pituitary enlargement, which was isointense to the gray matter (T1-weighted images) and homogeneously enhanced. Microscopic examination of the dura mater showed a marked increase of collagen fibers and various inflammatory cells. The anterior pituitary lobe was infiltrated with lymphocytes, and normal tissues were displaced by increased collagen fibers. Hypertrophic cranial pachymeningitis, a rare clinical entity, is a progressive lesion prone to include the dura mater at the skull base and can be fatal. We report a case of hypertrophic cranial pachymeningitis involving the pituitary gland, and discuss the possible etiology of the association.

水頭症を合併した頭部肥厚性硬膜炎の1例

水頭症を合併した頭部肥厚性硬膜炎の1例

Hypertrophic cranial pachymeningitis causing progressive unilateral blindness: MR findings

A case of hypertrophic cranial pachymeningitis is described and the MR appearance presented. A gadopentetate-dimeglumine-enhanced MR scan enhanced markedly suggesting thickening and inflammation of dura and falx cerebri. The patient, a 72-year-old elderly man, had surprisingly little clinical abnormality. His only neurological manifestation was progressive unilateral blindness. The exact cause of his pachymeningitis was unknown, though neither rheumatoid arthritis nor other collagen disease was completely excluded.

Hypertrophie cranial pachymeningitis due to aspergillus flavus

A 59-year-old woman suffered from occipital headache and bilateral cranial nerve VII, VIII, IX, X, XI and right XII deficit after developing otitis media. Magnetic resonance imaging (MRI) showed a thickening of the dura mater which was enhanced by gadolinium-DTPA (Gd). Aspergillus flavus was identified from the culture of otorrhea. She was treated with miconazole, flucytosin and fluconazole, which resulted in an improvement of the clinical symptoms and a thinning of the Gd-enhanced lesions on MRI. This is the first case of hypertrophic cranial pachymeningitis caused by Asp. flavus infection.