Idiopathic Hypertrophic Cranial Pachymeningitis Masquerading as Tolosa-Hunt Syndrome

Dong Hee Kim; Yun Su Hwang; Hak Seung Lee; Hyun Young Park

doi:10.14253/kjcn.2016.18.1.11

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Kim, Hwang, Lee, and Park: Idiopathic Hypertrophic Cranial Pachymeningitis Masquerading as Tolosa-Hunt Syndrome

Case Report

J Korean Ophthalmol Soc 2016;18(1):11-13.

Published online: 18 January 2016

DOI: https://doi.org/10.14253/kjcn.2016.18.1.11

Idiopathic Hypertrophic Cranial Pachymeningitis Masquerading as Tolosa-Hunt Syndrome

Dong Hee Kim¹, Yun Su Hwang², Hak Seung Lee^2,³, Hyun Young Park^2,³

¹Department of Neurology, Wonkwang University Sanbon Medical Center, Gunpo, Korea

²Department of Neurology, Wonkwang University School of Medicine, Iksan, Korea

³Institute of Wonkwang Medical Science and Regional Cardiocerebrovascular Center, Iksan, Korea

Address for correspondence; Hyun Young Park Department of Neurology, Wonkwang University School of Medicine, 895 Muwang-Ro, Iksan 54538, Korea Tel: +82-63-859-1410 Fax: +82-63-842-7379 E-mail: hypppark@hanmail.net

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Idiopathic hypertrophic cranial pachymeningitis (ICHP) is diffuse inflammatory process of the dura mater. ICHP can produce similar presentation with Tolosa-Hunt syndrome (THS) if it involves cavernous sinus. A-29-year old male with persistent headache and no definite neurologic dysfunction was noted. Two weeks later, he complained of ophthalmoplegia, and his symptoms were thought to be manifestations of THS. Brain magnetic resonance images revealed diffuse thickened, enhanced pachymeninges in left tentorium. The patient was diagnosed with IHCP. We report a IHCP patient who showed very similar presentation as THS. (Korean J Clin Neurophysiol 2016;18:11-13)

Keywords: Pachymeningitis, Tolosa-Hunt syndrome, Ophthalmoplegia

REFERENCES

1.Muthukumar N., Senthilbabu S., Usharani K. Idiopathic hypertrophic cranial pachymeningitis masquerading as Tolosa-Hunt syndrome. J Clin Neurosci. 2005. 12:589–592.

2.Abhilash K., Minimol KL. Idiopathic hypertrophic pachymeningitis. Int J Res Med Sci. 2013. 1:599–600.

3.Lee YC., Chueng YC., Hsu SW., Lui CC. Idiopathic hypertrophic cranial pachymeningitis: case report with 7 years of imaging follow-up. AJNR. 2003. 24:119–123.

4.Deus-Silva L., Queiroz Lde S., Zanardi Vd Vde A., Ghizoni E., Pereira Hda C., Malveira GL, et al. Hypertrophic pachymeningitis: case report. Arq Neuropsiquiatr. 2003. 61:107–111.

5.Friedman DP., Flanders AE. Enhanced MR imaging of hypertrophic pachymeningitis. Am J Roentgenol. 1997. 169:1425–1428.

6.Kumar I., Verma A., Srivastava A., Shukla RC. Idiopathic hypertrophic pachymeningitis? MRI diagnosis and follow up. J Neurol Disord. 2015. 3:1–4.

7.Son JY., Ahn BY., Kim DS. Idiopathic hypertrophic cranial pachymeningitis presenting with lower cranial nerve palsy mimicking meningioma. J Korean Neurol Assoc. 2006. 24:79–81.

Figure 1.

Brain MRI of patient. T1-and T2-weighted images reveled mild bulging soft tissues in the left cavernous sinus left cavernous sinus (A). Enhanced T1 weighted image show a thickening and enhancement of the left cavernous sinus and superior orbital fissure (B), and of the left tentorium (C). Three weeks later, abnormal enhancement is visible in the facial nerve (arrow), suggesting inflammatory facial nerve disease in T1-weighted images (D).

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