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
|
An Update on Idiopathic Hypertrophic Cranial Pachymeningitis for the Headache Practitioner. Curr Pain Headache Rep 2020; 24:57. [PMID: 32803475 DOI: 10.1007/s11916-020-00893-5] [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] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW We aim to review idiopathic hypertrophic cranial pachymeninigitis (IHCP), describe common head pain patterns and features associated with the disorder, suggest potential classification of head pain syndromes based on the recently published International Classification of Headache Disorders-3, explore pathophysiology found to be associated with cases of IHCP, and indicate common treatment for the disorder. RECENT FINDINGS It is suggested that a subset of IHCP is an IgG4-related autoimmune disorder. Patients with IHCP were found to have elevated cerebrospinal fluid (CSF) protein and lymphocytic pleocytosis. Corticosteroids are a mainstay of treatment. Other immunosuppressive agents and steroid sparing agents as add-on therapy may have utility in the treatment of cases refractory to corticosteroids alone. Clinical manifestations of IHCP depend upon the location of the inflammatory lesions and compression of the adjacent nervous system structures. Headache and loss of cranial nerve function were the most common presenting features of hypertrophic cranial pachymeninigitis. Several headache diagnoses may result from IHCP. Gadolinium-enhanced MRI is the standard imaging modality for diagnosing. Although the pathophysiology is poorly understood, many cases of hypertrophic pachymeninigitis (HP) are thought to be closely related to inflammatory disorders. Cases of HP previously thought to be idiopathic may have IgG4 pathophysiology. CSF and serological studies are helpful. Treatment involves immunosuppressive agents. Advancement in neuroimaging, assays, tests, and further delineation of inflammatory disorders affecting the nervous system may provide further insight to the etiology of cases of HP previously considered and diagnosed as idiopathic.
Collapse
|
3
|
Zhou Z, Li Q, Zheng J. Hypertrophic Cranial Pachymeningitis Induced by Long-Term Administration of Nonsteroidal Antiinflammatory Drugs. Ann Pharmacother 2017; 44:755-9. [PMID: 20197477 DOI: 10.1345/aph.1m455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective To report a case of hypertrophic cranial pachymeningitis (HCP) associated with the long-term administration of nonsteroidal antiinflammatory drugs (NSAIDs). Case summary 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 faix 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. Discussion 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. Conclusions 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.
Collapse
Affiliation(s)
- Zhujuan Zhou
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Qianning Li
- Department of Neurology, Xinqiao Hospital, Third Military Medical University
| | - Jian Zheng
- Department of Neurology, Xinqiao Hospital, Third Military Medical University
| |
Collapse
|
4
|
Tang R, Li F, Chen Q. A case report of atypical long segmental thoracic hypertrophic pachymeningitis with ossification of ligamentum flavum and literature review. 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 2017; 26:202-206. [PMID: 28365857 DOI: 10.1007/s00586-017-5030-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 03/02/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Thoracic spinal stenosis caused by ossification of ligamentum flavum (OLF) is frequently seen, but long segmental thoracic spinal cord compressed by consequent thickened ligament posteriorly was rarely reported. OBJECT To report a case of thoracic spinal cord compression caused by atypical long segmental thoracic hypertrophic pachymeningitis (HP) with OLF. METHODS A 55-year-old woman presenting with weakness and numbness in lower extremities was admitted to our department. Combined with physical examination and MRI results, diagnosis of HP with OLF was considered. Due to progressive neurological symptoms, thoracic decompression with internal fixation was performed. RESULTS The patient felt a reduced numbness and improvement in motor functions 5 days after surgery. Pathological examination suggested the diagnosis of HP with OLF. CONCLUSIONS HP is a rare condition characterized as thickening and enhancement of the dura mater on contrast-enhanced MRI and chronic inflammatory hyperplasia changes on biopsy. A case of atypical HP complicated with OLF is described. Chondrocytes infiltration in histological examination indicates the potential of ossification in HP.
Collapse
Affiliation(s)
- Ruofu Tang
- Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Street N88, Hangzhou, Zhejiang, China.
| | - Fangcai Li
- Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Street N88, Hangzhou, Zhejiang, China
| | - Qixin Chen
- Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Street N88, Hangzhou, Zhejiang, China
| |
Collapse
|
5
|
Cubides H, Londono J, Parra V, Saldarriaga E. Possible steroid-resistant IgG4-related pachymeningitis treated with parenteral methotrexate. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.rcreu.2016.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
6
|
Park TJ, Seo WD, Kim SY, Cho JH, Kim DH, Kim KH. Effective Response of Methotrexate for Recurrent Idiopathic Hypertrophic Spinal Pachymeningitis. KOREAN JOURNAL OF SPINE 2017; 13:200-203. [PMID: 28127378 PMCID: PMC5266097 DOI: 10.14245/kjs.2016.13.4.200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/22/2016] [Accepted: 12/23/2016] [Indexed: 11/19/2022]
Abstract
Idiopathic hypertrophic spinal pachymeningitis (IHSP) is a chronic progressive and diffuse inflammatory fibrosis of the spinal dura mater. Though treatment of IHSP is surgical decompression with steroid therapy, treatment for recurrent IHSP is controversial. Our patient was diagnosed with IHSP based on magnetic resonance imaging (MRI) and underwent laminectomy for decompression following steroid pulse therapy. Despite maintenance of steroid therapy, the patient experienced 3 recurrences. As an alternative immunosuppressant medication, methotrexate was introduced with low-dose steroid. Fortunately, the symptom was resolved, and a decrease of dura thickening was revealed on MRI. We present the case and suggest that methotrexate might be an effective treatment modality for recurrent IHSP.
Collapse
Affiliation(s)
- Tae Joon Park
- Department of Neurosurgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | | | - Sang Young Kim
- Department of Neurosurgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jae Hoon Cho
- Department of Neurosurgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Dae Hyun Kim
- Department of Neurosurgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Ki Hong Kim
- Department of Neurosurgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| |
Collapse
|
7
|
Gospodarev V, Câmara J, Chakravarthy V, Perry A, Wood M, Dietz R, Wang J, De Los Reyes K, Raghavan R. Treatment of IgG4-related pachymeningitis in a patient with steroid intolerance: The role of early use of rituximab. J Neuroimmunol 2016; 299:62-65. [DOI: 10.1016/j.jneuroim.2016.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/01/2016] [Accepted: 08/08/2016] [Indexed: 12/17/2022]
|
8
|
Kim EH, Kim SH, Cho JM, Ahn JY, Chang JH. Immunoglobulin G4–related hypertrophic pachymeningitis involving cerebral parenchyma. J Neurosurg 2011; 115:1242-7. [DOI: 10.3171/2011.7.jns1166] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report a case of IgG4-related hypertrophic pachymeningitis that involved cerebral parenchyma. The mass was removed surgically. Histopathological studies showed diffuse infiltration of lymphoplasmacytic cells without evidence of Langerhans histiocytes or meningothelial cells. Immunoglobulin G4 was strongly positive on immunohistochemical staining. The Gd-enhanced lesion deep inside brain parenchyma was completely resolved after 3 months of oral corticosteroid medication. A nodular type of hypertrophic pachymeningitis that mimics a meningioma is rare. Nevertheless, preoperative presumption is very important, and immunohistochemical studies for IgG4 may be helpful in the differential diagnosis.
Collapse
Affiliation(s)
- Eui Hyun Kim
- 1Departments of Neurosurgery and
- 3Neuro-Oncology Clinic, and
| | - Se Hoon Kim
- 2Pathology,
- 3Neuro-Oncology Clinic, and
- 4Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Mo Cho
- 1Departments of Neurosurgery and
- 3Neuro-Oncology Clinic, and
| | | | - Jong Hee Chang
- 1Departments of Neurosurgery and
- 3Neuro-Oncology Clinic, and
- 4Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
9
|
Abouzaid C, Kissani N, Essaadouni L. Pachyméningite crânienne et syndrome de Gougerot-Sjögren primitif. Rev Neurol (Paris) 2011; 167:348-51. [DOI: 10.1016/j.neurol.2010.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 07/25/2010] [Accepted: 08/27/2010] [Indexed: 11/17/2022]
|
10
|
A case of subarachnoid hemorrhage with pituitary apoplexy caused by idiopathic hypertrophic pachymeningitis. Neurol Sci 2010; 32:455-9. [DOI: 10.1007/s10072-010-0343-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 05/23/2010] [Indexed: 10/19/2022]
|
11
|
Bhatia R, Tripathi M, Srivastava A, Garg A, Singh MB, Nanda A, Padma MV, Prasad K. Idiopathic hypertrophic cranial pachymeningitis and dural sinus occlusion: two patients with long-term follow up. J Clin Neurosci 2009; 16:937-42. [PMID: 19375919 DOI: 10.1016/j.jocn.2008.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Revised: 06/20/2008] [Accepted: 08/17/2008] [Indexed: 10/20/2022]
Abstract
Idiopathic hypertrophic cranial pachymeningitis (IHPM) is a clinicopathological entity characterized by thickening and fibrosis of the dura mater with resultant clinical symptoms. It is generally steroid responsive and has a tendency to remit and relapse. We present here two patients with IHPM with associated dural sinus occlusion and describe their clinicoradiological features and long-term course and outcome.
Collapse
Affiliation(s)
- R Bhatia
- Department of Neurology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Im SH, Cho KT, Seo HS, Choi JS. Idiopathic hypertrophic cranial pachymeningitis presenting with headache. Headache 2008; 48:1232-5. [PMID: 18547269 DOI: 10.1111/j.1526-4610.2008.01140.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Idiopathic hypertrophic cranial pachymeningitis is a rare inflammatory disease, usually involving the dura mater of skull base, tentorium, and falx. Chronic headache is the most common clinical manifestations. We report a case of idiopathic hypertrophic cranial pachymeningitis that was, initially, misdiagnosed as acute subdural hematoma along the tentorium cerebelli and posterior falx on the brain precontrast CT scan of a patient with severe headache. Correct diagnosis of pachymeningitis was made only after brain magnetic resonance imaging and meningeal biopsy.
Collapse
Affiliation(s)
- So-Hyang Im
- Department of Neurosurgery, Dongguk University Hospital, Gyeonggi-do, Korea
| | | | | | | |
Collapse
|
13
|
van Toorn R, Esser M, Smit D, Andronikou S. Idiopathic hypertrophic cranial pachymeningitis causing progressive polyneuropathies in a child. Eur J Paediatr Neurol 2008; 12:144-7. [PMID: 17881263 DOI: 10.1016/j.ejpn.2007.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Revised: 07/25/2007] [Indexed: 10/22/2022]
Abstract
We describe the clinical manifestations, radiological features and response to therapy of a 10-year-old child with idiopathic hypertrophic cranial pachymeningitis, a rare condition with potentially severe disabling neurological consequences. The child presented with progressive cranial polyneuropathies secondary to dural compression of the neural and vascular structures within the cavernous sinus. Corticosteroids and methotrexate proved effective in inducing near complete and sustained remission of the condition. To our knowledge, this is the first case reported of idiopathic hypertrophy cranial pachymeningitis in a child. The experience with oral methotrexate to treat this entity in a child has also never been reported. Idiopathic cranial hypertrophic pachymeningitis should be considered in children presenting with a progressive cranial polyneuropathies.
Collapse
Affiliation(s)
- Ronald van Toorn
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Tygerberg Hospital, Tygerberg, Western Cape, South Africa.
| | | | | | | |
Collapse
|
14
|
Togashi M, Komatsuda A, Masai R, Maki N, Hatakeyama T, Wakui H, Sawada KI. Hypertrophic cranial pachymeningitis in a patient with Cogan’s syndrome. Clin Rheumatol 2008; 27 Suppl 1:S33-5. [DOI: 10.1007/s10067-008-0841-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Revised: 01/05/2008] [Accepted: 01/07/2008] [Indexed: 10/22/2022]
|
15
|
Idiopathic hypertrophic cranial pachymeningitis treated by oral methotrexate: a case report and review of literature. Rheumatol Int 2007; 28:713-8. [PMID: 18094971 PMCID: PMC2292418 DOI: 10.1007/s00296-007-0504-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Accepted: 11/17/2007] [Indexed: 10/28/2022]
Abstract
Idiopathic hypertrophic cranial pachymeningitis (IHCP) is a rare clinical entity, characterized by a chronic inflammation causing thickening of the dura. Adequate therapeutic management is still a matter of debate. We present a patient with an IHCP, non-responsive to corticotherapy. Oral methotrexate was introduced (12.5 mg weekly) and total remission was observed after 6 weeks, both clinically and after neuro-imaging. We conclude that methotrexate can be effective and a therapeutical option in patients with IHCP who are resistant to corticotherapy or present major side-effects of chronic corticosteroids use.
Collapse
|