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Review
. 2008 May;28(7):713-8.
doi: 10.1007/s00296-007-0504-5. Epub 2007 Dec 19.

Idiopathic hypertrophic cranial pachymeningitis treated by oral methotrexate: a case report and review of literature

T Bosman  1 , C Simonin, D Launay, S Caron, A Destée, L Defebvre
Affiliations
Review

Idiopathic hypertrophic cranial pachymeningitis treated by oral methotrexate: a case report and review of literature

T Bosman et al. Rheumatol Int. 2008 May.

Abstract

Idiopathic hypertrophic cranial pachymeningitis (IHCP) is a rare clinical entity, characterized by a chronic inflammation causing thickening of the dura. Adequate therapeutic management is still a matter of debate. We present a patient with an IHCP, non-responsive to corticotherapy. Oral methotrexate was introduced (12.5 mg weekly) and total remission was observed after 6 weeks, both clinically and after neuro-imaging. We conclude that methotrexate can be effective and a therapeutical option in patients with IHCP who are resistant to corticotherapy or present major side-effects of chronic corticosteroids use.

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Figures

Fig. 1
Fig. 1
Axial (a) and coronal (b) T1-weighted contrast-enhanced MR images show markedly thickened and enhanced dura extending from the vertex to the tentorium
Fig. 2
Fig. 2
Axial (a) and coronal (b) T1-weighted contrast-enhanced MR images show progression of dural thickening corresponding with the clinical worsening at the time of the biopsy
Fig. 3
Fig. 3
Axial (a) and coronal (b) T1-weighted contrast-enhanced MR images obtained 6 weeks after introduction of methotrexate show regression of dural thickening and enhancement
See this image and copyright information in PMC

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