1
|
Margoni M, Barbareschi M, Rozzanigo U, Sarubbo S, Chioffi F, Tanel R. Idiopathic hypertrophic cranial pachymeningitis as a rare cause of status epilepticus. Neurol Sci 2019; 40:2193-2195. [PMID: 31154557 DOI: 10.1007/s10072-019-03954-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Monica Margoni
- Department of Neurosciences DNS, University Hospital of Padova, Padua, Italy. .,Padova Neuroscience Center (PNC), Padua, Italy.
| | | | | | - Silvio Sarubbo
- Division of Neurosurgery, Department of Neurosciences, Santa Chiara Hospital, Trento, Italy.,Structural and Functional Connectivity Lab, Division of Neurosurgery, Santa Chiara Hospital, Trento, Italy
| | - Franco Chioffi
- Division of Neurosurgery, Department of Neurosciences, Santa Chiara Hospital, Trento, Italy.,Structural and Functional Connectivity Lab, Division of Neurosurgery, Santa Chiara Hospital, Trento, Italy
| | - Raffaella Tanel
- Division of Neurology, Department of Neurosciences, Santa Chiara Hospital, Trento, Italy
| |
Collapse
|
2
|
Boisch G, Duda S, Hartmann C, Weßling H. Hypertrophic pachymeningoencephalitis associated with temporal giant cell arteritis. BMJ Case Rep 2018; 2018:bcr-2018-225304. [PMID: 30262524 DOI: 10.1136/bcr-2018-225304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report the rare case of an 80-year-old male patient with hypertrophic pachymeningoencephalitis that may be associated with temporal arteritis. The patient presented to our neurological department with a 2-week history of latent paresis and ataxia affecting his right hand. He had been diagnosed with temporal arteritis 12 years earlier. Brain MRI showed an enhancement of the left-sided frontoparietal meninges with oedema of the adjacent tissue of the precentral and postcentral cortex. A leptomeningeal biopsy was performed. An autoimmune-mediated immunoglobulin G4-associated hypertrophic pachymeningoencephalitis was diagnosed. The patient received a high-dose corticosteroid therapy and his symptoms gradually improved. Our results suggest that hypertrophic pachymeningoencephalitis may occur as a complication of giant cell arteritis and may cause central neurological deficits by cerebral perifocal oedema.
Collapse
Affiliation(s)
- Gesine Boisch
- Department of Neurology, Ammerland Klinik GmbH, Westerstede, Germany
| | - Sven Duda
- Department of Neurosurgery, Bundeswehrkrankenhaus Westerstede, Westerstede, Germany
| | - Christian Hartmann
- Department of Neuropathology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Heinrich Weßling
- Department of Neurosurgery, Bundeswehrkrankenhaus Westerstede, Westerstede, Germany
| |
Collapse
|
3
|
Kanoke A, Ogawa Y, Watanabe M, Kumabe T, Tominaga T. Autoimmune hypophysitis presenting with intracranial multi-organ involvement: three case reports and review of the literature. BMC Res Notes 2013; 6:560. [PMID: 24373428 PMCID: PMC3877864 DOI: 10.1186/1756-0500-6-560] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 12/16/2013] [Indexed: 11/23/2022] Open
Abstract
Background Autoimmune hypophysitis very rarely spreads to nearby organs outside the pituitary tissue, for unknown reasons, with only 5 reported cases of hypophysitis spreading over the cavernous sinus. Case presentation Three patients presented with cases of non-infectious hypophysitis spreading outside the pituitary tissue over the cavernous sinus. All three cases were diagnosed with histological confirmation by transsphenoidal surgery, and the patients showed remarkable improvement with postoperative pulse dose steroid therapy, including disappearance of abnormal signal intensities in the bilateral hypothalami on magnetic resonance imaging, resolution of severe stenosis of the internal carotid artery, and normalization of swollen pituitary tissues. Two of 3 cases fulfilled the histological criteria of immunoglobulin G4-related disease, although none of the patients had high serum immunoglobulin G4 level. Conclusion The true implications of such unusual spreading of hypophysitis to nearby organs are not fully understood, but the mechanism of occurrence might vary according to the timing of inflammation in this unusual mode of spreading. Pulse dose steroid therapy achieved remarkably good outcomes even in the patient with progressive severe stenosis of the internal carotid artery and rapid visual deterioration.
Collapse
Affiliation(s)
| | - Yoshikazu Ogawa
- Department of Neurosurgery, Kohnan Hospital, 4-20-1 Nagamachiminami, Taihaku-ku, Sendai 982-8523, Miyagi, Japan.
| | | | | | | |
Collapse
|
4
|
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.
Collapse
Affiliation(s)
- Yanire Sánchez Medina
- Servicio de Neurocirugía, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz, Tenerife, España.
| | | | | | | | | |
Collapse
|
5
|
Bjørke AB, Wahl CM, Kalstad S. A man in his 40s with headache and blurred vision. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:1353-6. [PMID: 22717862 DOI: 10.4045/tidsskr.11.0718] [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
|
6
|
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
|
7
|
Schönermark MP, Issing P, Stöver T, Ruh S, Lenarz T. Fibroinflammatory pseudotumor of the temporal bone. Skull Base Surg 2011; 8:45-50. [PMID: 17171042 PMCID: PMC1656655 DOI: 10.1055/s-2008-1058590] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Chronic inflammatory tumor-like lesions of the temporal bone represent a difficult clinical task for the skull base surgeon. Their osteolytic aggressiveness endangers vital structures and may not be controlled by surgery alone. We present the course of four cases of fibroinflammatory pseudotumor of the temporal bone which were treated by a combined approach of skull base surgery and chemotherapy. Three patients were deafened by the disease and underwent several operafive measures. One patient was lost, most likely due to an arrosive bleeding of the internal carotid artery. The chronic and recurrent process could only be stopped by petrosectomy, followed by antiproliferative chemotherapy. Two patients were subsequently provided with a cochlear implant. The differential diagnosis, diagnostic, and operative options of this rare but severe disease are discussed.
Collapse
|
8
|
Ranasinghe MG, Zalatimo O, Rizk E, Specht CS, Reiter GT, Harbaugh RE, Sheehan J. Idiopathic hypertrophic spinal pachymeningitis. J Neurosurg Spine 2011; 15:195-201. [PMID: 21568651 DOI: 10.3171/2011.4.spine1037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Spinal idiopathic hypertrophic pachymeningitis (IHP) is a rare, chronic, nonspecific, granulomatous inflammatory disorder of the dura with unknown etiology. It can cause a localized or diffuse thickening of the dura mater with compression of the spinal canal and possible myelopathic symptoms. The authors report 3 consecutive cases of spinal IHP with a review of the literature. The diagnosis of spinal IHP was based on biopsy and pathological confirmation. Typical MR imaging findings suggestive of spinal IHP were noted in all cases. The clinical course may be marked by deterioration despite conservative therapy and may require surgical intervention to prevent irreversible neurological damage. Therefore, prompt diagnosis and institution of proper treatment is critical.
Collapse
Affiliation(s)
- Moksha G Ranasinghe
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA.
| | | | | | | | | | | | | |
Collapse
|
9
|
Lu YR, Yeh JH, Tsai MD, Lee CC, Chen WH. Focal Idiopathic Hypertrophic Pachymeningoencephalitis. J Formos Med Assoc 2008; 107:181-4. [DOI: 10.1016/s0929-6646(08)60132-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
10
|
Matsushita T, Murai H, Kawajiri M, Muratani H, Iwaki T, Taniwaki T, Kira JI. Character changes from idiopathic cranial pachymeningoencephalitis. J Neurol Sci 2006; 244:163-6. [PMID: 16504209 DOI: 10.1016/j.jns.2006.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2005] [Revised: 01/03/2006] [Accepted: 01/04/2006] [Indexed: 11/24/2022]
Abstract
A 66-year-old man with idiopathic cranial pachymeningoencephalitis was described. He suffered from left orbital pain, and character changes. He became short tempered, and was very attached to trifles. Two years prior to these symptoms, he had developed transient left abducent nerve palsy. Head MRI showed a thickening and enhancement of the dura mater on gadolinium-enhanced T1-weighted images, and high signal intensity lesions at bilateral frontal lobes predominantly in the white matter on T2-weighted images. Biopsies revealed microglial proliferation in the cerebral parenchyma, and mild lymphocytic perivascular infiltration. No evidence of intracranial infection was detected. We therefore treated him with methylprednisolone pulse therapy followed by oral prednisolone. His character became gradually normalized, and bilateral frontal lobe lesions seen on MRI disappeared. This is the first case to describe recurrent pachymeningoencephalitis with character changes, and symptoms were probably due to frontal lobe dysfunction.
Collapse
Affiliation(s)
- Takuya Matsushita
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | | | | | | | | | | | | |
Collapse
|
11
|
Muthukumar N, Senthilbabu S, Usharani K. Idiopathic hypertrophic cranial pachymeningitis masquerading as Tolosa-Hunt syndrome. J Clin Neurosci 2005; 12:589-92. [PMID: 16051099 DOI: 10.1016/j.jocn.2004.08.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2003] [Accepted: 08/05/2004] [Indexed: 10/25/2022]
Abstract
Idiopathic hypertrophic cranial pachymeningitis is a rare condition. A case of idiopathic hypertrophic cranial pachymeningitis presenting as Tolosa-Hunt syndrome is being reported. The importance of neuroimaging in patients with suspected Tolosa-Hunt syndrome is discussed. Tolosa-Hunt syndrome might represent a focal manifestation of Idiopathic hypertrophic cranial pachymeningitis. Future studies are necessary to further clarify the relationship between these two conditions.
Collapse
Affiliation(s)
- N Muthukumar
- Department of Neurosurgery, Madurai Medical College, Madurai, India.
| | | | | |
Collapse
|
12
|
Tuncel D, Yücesan C, Erden E, Savaş A, Erden I, Mutluer N. Idiopathic hypertrophic cranial pachymeningitis with perifocal brain edema. Clin Neurol Neurosurg 2005; 107:249-52. [PMID: 15823684 DOI: 10.1016/j.clineuro.2004.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2003] [Revised: 05/24/2004] [Accepted: 06/08/2004] [Indexed: 10/26/2022]
Abstract
Idiopathic hypertrophic cranial pachymeningitis (IHCP) consists of meningeal thickening due to chronic inflammation for which no cause such as infection, specific granulomatous disease, or malignancy is demonstrable. We present a case of IHCP with perifocal brain edema suggesting mass lesion with its magnetic resonance imaging (MRI) and pathologic findings. A 36-year-old woman was admitted to our hospital in August 2001 with a complaint of motor weakness in her left leg for 1 month. Magnetic resonance imaging with gadolinium revealed enhancement of the thickened dura mater and perifocal edema in the right frontoparietal region suggesting a mass lesion. Histological examination of the biopsy specimen revealed a dense fibrous cellular tissue. There was no obvious inflammatory infiltrate but in some areas between fibrous bundles one or two lymphocytes were detected. According to our knowledge, our patient is the second report in the literature of IHCP with focal edema causing a mass effect.
Collapse
Affiliation(s)
- Deniz Tuncel
- Department of Neurology, Ankara University Faculty of Medicine, Ankara, Turkey.
| | | | | | | | | | | |
Collapse
|
13
|
Kon T, Ishihara N, Kamimura T, Tanaka R, Ito J, Horikawa Y, Saito I. Unusual MRI findings of hypertrophic pachymeningitis with irregular dural thickening and severe brain oedema. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.ejrex.2004.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
Yamakita N, Hanamoto T, Muraoka N, Ikeda T, Hirata T, Yasuda K, Sano T. Hypopituitarism and Diabetes Insipidus with Localized Hypertrophic Pachymeningitis (Tolosa-Hunt Syndrome) Associated with Hashimoto Thyroiditis. Am J Med Sci 2004; 327:38-43. [PMID: 14722395 DOI: 10.1097/00000441-200401000-00008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report a 69-year-old woman with intracranial pachymeningitis showing hypopituitarism, diabetes insipidus, and Tolosa-Hunt syndrome associated with Hashimoto thyroiditis confirmed by autopsy. A large tumorous lesion of the hypothalamo-pituitary gland was revealed on magnetic resonance imaging, after the patient complained of gait and visual field disturbance. These symptoms subsided after thyroid hormone supplementation. Hypopituitarism and diabetes insipidus were diagnosed after cessation of the treatment by the patient herself. Multiple cranial nerve palsies and orbito-frontalgia appeared. Methylprednisolone pulse therapy improved the symptoms, but they recurred when the dose of glucocorticoid was decreased. The patient died of brain thrombosis. Autopsy revealed typical findings of Hashimoto thyroiditis and intracranial pachymeningitis involving the cranial base and pituitary gland. The high titer of rheumatoid factor and Hashimoto thyroiditis in this patient suggest an immunological role in the pathogenesis of pachymeningitis.
Collapse
Affiliation(s)
- Noriyoshi Yamakita
- Department of Internal Medicine, Matsunami Generl Hospital, Kasamatsu, Japan.
| | | | | | | | | | | | | |
Collapse
|
15
|
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]
|
16
|
Hatano N, Behari S, Nagatani T, Kimura M, Ooka K, Saito K, Yoshida J. Idiopathic hypertrophic cranial pachymeningitis: clinicoradiological spectrum and therapeutic options. Neurosurgery 1999; 45:1336-42; discussion 1342-4. [PMID: 10598701 DOI: 10.1097/00006123-199912000-00014] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Idiopathic hypertrophic cranial pachymeningitis is a rare disease, of undetermined pathogenesis, that is characterized by inflammation and fibrosis of the dura mater. METHODS We encountered six patients with idiopathic hypertrophic cranial pachymeningitis and analyzed their clinical presentations, radiological findings, and treatment. RESULTS In the six patients, the main manifestations were cranial nerve palsies and headache. Three associations were present, namely optic neuropathy, Tolosa-Hunt syndrome, and diabetes insipidus. Gadolinium-enhanced magnetic resonance imaging was diagnostic, showing intense dural enhancement in a linear or nodular pattern. The responses to corticosteroid therapy were better for patients who exhibited linear, rather than nodular, dural enhancement. For one patient, surgical decompression of the superior orbital fissure provided lasting relief. The course of the disease followed one of three patterns, i.e., sustained remission, relapse with corticosteroid independence, or relapse with corticosteroid dependence. Pulse corticosteroid therapy provided significant relief, while reducing the daily corticosteroid requirement and avoiding side effects, for a corticosteroid-dependent relapsing patient. CONCLUSION Idiopathic hypertrophic cranial pachymeningitis exhibits varied clinical courses. It is important to prevent irreversible cranial neuropathy during the active phase of the disease, using daily administration of corticosteroids, pulse corticosteroid therapy, or surgical decompression.
Collapse
Affiliation(s)
- N Hatano
- Department of Neurosurgery, Nagoya University School of Medicine, Japan
| | | | | | | | | | | | | |
Collapse
|
17
|
Fain O, Seror O, Wirth JF, Heron C, Mathieu E, Chamouard JM, Guillevin L, Thomas M. [Cranial pachymeningitis]. Rev Med Interne 1999; 20:234-46. [PMID: 10216880 DOI: 10.1016/s0248-8663(99)83051-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Pachymeningitis is a fibrous inflammatory process with non-specific symptoms, involving the dura mater. Due to MRI development, diagnosis is both easier and earlier. CURRENT KNOWLEDGE AND KEY POINTS We report seven cases and review current literature. Clinical features are headaches and cranial nerve palsies. CSF shows inflammatory changes, while MRI evidences thickening of the dura mater. Disease etiologies in the present study were tuberculosis in two cases, sarcoidosis, Lyme disease, lymphoma and dural puncture; in one case only the disease was of unknown origin. The condition of six patients improved with specific treatment. FUTURE PROSPECTS AND PROJECTS Further MRI development should allow detection of new forms of pachymeningitis and standardization of patients' management through the study of more important series.
Collapse
Affiliation(s)
- O Fain
- Service de médecine interne, hôpital Jean-Verdier, Bondy, France
| | | | | | | | | | | | | | | |
Collapse
|