Idiopathic Hypertrophic Cranial Pachymeningitis Misdiagnosed as Acute Subtentorial Hematoma.
10.3340/jkns.2010.48.2.181
- Author:
Ik Seong PARK
1
;
Hoon KIM
;
Eun Yong CHUNG
;
Kwang Wook CHO
Author Information
1. Department of Neurosurgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea. jkw94@naver.com
- Publication Type:Case Report
- Keywords:
Pachymeningitis;
Subtentorial hematoma;
Lower cranial nerve palsy
- MeSH:
Adenoma;
Adult;
Biopsy;
Brain;
Cranial Nerve Diseases;
Craniocerebral Trauma;
Diagnosis, Differential;
Eye;
Follow-Up Studies;
Headache;
Hematoma;
Hematoma, Subdural;
Hematoma, Subdural, Acute;
Humans;
Inflammation;
Lung Neoplasms;
Magnetic Resonance Imaging;
Male;
Meningitis;
Neoplasm Metastasis;
Scleritis;
Thorax;
Uveitis
- From:Journal of Korean Neurosurgical Society
2010;48(2):181-184
- CountryRepublic of Korea
- Language:English
-
Abstract:
A case of idiopathic hypertrophic cranial pachymeningitis (IHCP) misdiagnosed as an acute subdural hematoma is reported. A 37-year-old male patient presented with headache following head trauma 2 weeks earlier. Computerized tomography showed a diffuse high-density lesion along the left tentorium and falx cerebri. Initial chest X-rays revealed a small mass in the right upper lobe with right lower pleural thickening, which suggested lung cancer, such as an adenoma or mediastinal metastasis. During conservative treatment under the diagnosis of a subdural hematoma, left cranial nerve palsies were developed (3rd and 6th), followed by scleritis and uveitis involving both eyes. Magnetic resonance imaging (MRI) revealed an unusual tentorium-falx enhancement on gadolinium-enhanced T1-weighted images. Non-specific chronic inflammation of the pachymeninges was noticed on histopathologic examination following an open biopsy. Systemic steroid treatment was initiated, resulting in dramatic improvement of symptoms. A follow-up brain MRI showed total resolution of the lesion 2 months after steroid treatment. IHCP should be included in the differential diagnosis of subtentorial-enhancing lesions.
