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Senda M, Ueda A, Ito M, Shima S, Mizutani Y, Mutoh T, Watanabe H. Long-term response to immunotherapy in patients with hypertrophic pachymeningitis. FUJITA MEDICAL JOURNAL 2023; 9:35-40. [PMID: 36789128 PMCID: PMC9923450 DOI: 10.20407/fmj.2021-026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/05/2022] [Indexed: 02/16/2023]
Abstract
Objective In this study, we aimed to clarify the relationship between initial treatment response, prednisolone (PSL) dosage, clinical type, and recurrence in patients with hypertrophic pachymeningitis (HP). Methods The study cohort comprised eight patients with HP who had been admitted to our hospital from April 2015 to June 2020. Diagnostic criteria for HP included neurological abnormalities and dural thickening on magnetic resonance gadolinium-enhanced T1-weighted images. Results Relevant characteristics of the eight study patients are as follows. There were two men and six women. The average age at onset was 58.3 (range: 29-79) years. Three of them had myeloperoxidase-antineutrophil cytoplasmic antibody-related vasculitis, one immunoglobulin G4-related disease, and one ulcerative colitis. The remaining three patients had idiopathic HP. The average maximum dosage of PSL was 0.79 mg/kg/day, and the average daily maintenance dosage 0.18 mg/kg/day. Three patients needed additional immunosuppressive drugs. Both idiopathic and secondary HP initially responded well to PSL, with improvement in activities of daily living. Six patients had some sequelae related to cranial nerve involvement. No relapses occurred while the patients were taking moderate doses of PSL; however, all patients with idiopathic HP had recurrences when their PSL dosage was reduced. Conclusions Patients with idiopathic HP and HP associated with immune disorders respond to steroids and immunosuppressive drugs and recover well. However, there is a high rate of relapse after reduction of PSL dosage, mainly in those with idiopathic HP.
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Affiliation(s)
- Mayumi Senda
- Department of Neurology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan,Department of Neurology, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Akihiro Ueda
- Department of Neurology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Mizuki Ito
- Department of Neurology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan,Department of Neurology, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Sayuri Shima
- Department of Neurology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Yasuaki Mizutani
- Department of Neurology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Tatsuro Mutoh
- Department of Neurology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Hirohisa Watanabe
- Department of Neurology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
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Headache, chest pain, and multiplex cranial neuropathy. Neurol Sci 2019; 40:1477-1480. [DOI: 10.1007/s10072-019-3718-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/10/2019] [Indexed: 10/26/2022]
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Yacoub HA, Li PM, Bemporad JA, Khaitov D, Brown DF. Hypertrophic cervical spine pachymeningitis due to sarcoidosis: a case report. Hosp Pract (1995) 2019; 47:99-103. [PMID: 30682899 DOI: 10.1080/21548331.2019.1575645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hypertrophic pachymeningitis (HP) is a chronic, progressive diffuse inflammatory condition that leads to thickening of the dura mater and can be idiopathic or associated with sarcoidosis among other disorders. In this case report, we present a rare case of cervical spine HP in a 29-year-old woman in the post-partum period, who had a history of pituitary adenoma and juvenile rheumatoid arthritis. Magnetic resonance imaging (MRI) of the spine revealed a soft tissue mass and moderate cord compression. The patient underwent C3-C7 laminectomy. Pathological analysis of the cervical epidural mass demonstrated a reactive inflammatory cell process. Recurrence of symptoms and worsening of pachymeningitis on imaging studies warranted further work-up which revealed mediastinal/hilar lymphadenopathy. Transbronchial biopsy revealed non-caseating granulomatous disease consistent with sarcoidosis. The patient was started on oral steroids and eventually methotrexate with significant clinical and radiographic improvement. Follow-up imaging studies showed minimal dural thickening in the thoracic spine and eventually complete resolution. HP should be considered in a patient with spinal cord compression, myelopathy, and radicular pain of unclear etiology, and sarcoidosis should be considered in idiopathic cases.
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Affiliation(s)
- Hussam A Yacoub
- a Departments of Medicine (Division of Neurology) , Lehigh Valley Health Network , Allentown , PA , USA
| | - P Mark Li
- b Surgery (Division of Neurological/Spine Surgery) , Lehigh Valley Health Network , Allentown , PA , USA
| | | | - Dmitry Khaitov
- a Departments of Medicine (Division of Neurology) , Lehigh Valley Health Network , Allentown , PA , USA
| | - Daniel F Brown
- d Pathology , Lehigh Valley Health Network , Allentown , PA , USA
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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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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.
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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
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Navalpotro-Gómez I, Vivanco-Hidalgo RM, Cuadrado-Godia E, Medrano-Martorell S, Alameda-Quitllet F, Villalba-Martínez G, Roquer J. Focal status epilepticus as a manifestation of idiopathic hypertrophic cranial pachymeningitis. J Neurol Sci 2016; 367:232-6. [PMID: 27423594 DOI: 10.1016/j.jns.2016.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 05/27/2016] [Accepted: 06/09/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Idiopathic hypertrophic cranial pachymeningitis (IHCP) is an uncommon disease of unknown etiology characterized by thickening of the cerebral dura mater with possible associated inflammation. The most frequently described clinical symptoms include headache, cranial nerve palsy, and cerebellar dysfunction. Epilepsy and/or status epilepticus as main presentation is very uncommon. CASE PRESENTATION Two consecutive cases are presented of patients manifesting focal status epilepticus secondary to IHCP, with clinical, laboratory [blood test and cerebrospinal fluid (CSF) analysis], neuroradiologic [magnetic resonance imaging (MRI) at 3 Tesla and digital subtraction angiography (DSA)], and therapeutic data. One patient underwent meningeal biopsy; pathology findings are also included. Corticosteroid therapy resulted in clinical improvement in both cases, and neuroimaging showed decreased abnormal morphology, compared to initial findings. CONCLUSION In the diagnostic approach to focal status epilepticus or epilepsy, IHCP must be considered a potential, although extremely infrequent, cause. Anti-inflammatory treatment is an effective addition to antiepileptic drug therapy in patients with IHCP.
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Affiliation(s)
| | - Rosa María Vivanco-Hidalgo
- Department of Neurology, Hospital Universitari del Mar, Barcelona, Spain; Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elisa Cuadrado-Godia
- Department of Neurology, Hospital Universitari del Mar, Barcelona, Spain; Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | | | - Jaume Roquer
- Department of Neurology, Hospital Universitari del Mar, Barcelona, Spain; Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona, Barcelona, Spain
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Mohanasundaram K, Mahendran B, Mani M, Saravanan M, Rajeswari S. Compressive myelopathy: A rare clinical presentation of IgG4-related disease. INDIAN JOURNAL OF RHEUMATOLOGY 2016. [DOI: 10.4103/0973-3698.193587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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