Idiopathic hypertrophic pachymeningitis mimicking neurosarcoidosis

• Published in: Clinical neurology and neurosurgery Vol. 114; no. 2; pp. 176 - 178
• Main Authors: Christakis, Panos G, Machado, Duarte G, Fattahi, Pooia
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 01.02.2012; Elsevier; Elsevier Limited
• Subjects: Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Antibiotics; Bells palsy; Biological and medical sciences; Biopsy; Central Nervous System Diseases - diagnosis; Central Nervous System Diseases - pathology; Cranial Nerve Diseases - diagnosis; Cranial Nerve Diseases - pathology; Diagnosis, Differential; Dura Mater - pathology; Dural biopsy; Dysphagia; Family medical history; Female; Fever; Headaches; Hearing loss; Hearing Loss - etiology; Histopathology; Hospitals; Humans; Idiopathic hypertrophic pachymeningitis; Lyme disease; Magnetic Resonance Imaging; Medical sciences; Meningitis - diagnosis; Meningitis - pathology; Middle Aged; Multiple cranial neuropathies; Neurology; Neurosarcoidosis; Neurosurgery; Prednisone - therapeutic use; Sarcoidosis; Sarcoidosis - diagnosis; Sarcoidosis - pathology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tinnitus - etiology; Tomography, X-Ray Computed; Histopathology; Idiopathic hypertrophic pachymeningitis; Multiple cranial neuropathies; Neurosarcoidosis; Dural biopsy; Nervous system diseases; Sarcoidosis; Idiopathic; Neuropathy; Differential diagnostic; Pachymeningitis; Biopsy; Surgery; Systemic disease
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2011.10.011

Serum labs were all unremarkable, and included an ACE level, VDRL, Lyme disease titer and HIV ELISA, PCRs for HSV, VZV and enteroviridae, mycology and acid fast bacilli smears and cultures, extractable nuclear antibodies panel (Anti-RNP, Anti-Sm, Anti-SS-A, Anti-SS-B, Scl-70, Anti-Jo-1), acetylcholine receptor antibody, ANA, ANCA, cryoglobulin, and cardiolipin antibody tests, hepatitis panel and thyroid function tests. Contrast-enhanced MRI imaging typically demonstrates thickened dura, and symptoms are thought to be as a result of fibrous entrapment or ischemic damage of neurovascular structures [1-3].\n However, failure to correctly identify and treat primary etiologies such as infection and malignancy may have devastating consequences, and inadequate treatment of IHP may result in irreversible vision loss, status epilepticus, and paralysis [1,2].