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Case Reports
. 2014 Apr 16:5:52.
doi: 10.4103/2152-7806.130907. eCollection 2014.

Cranio cervical tuberculous hypertrophic pachymeningitis

Satya Bhusan Senapati  1 , Sudhansu Sekhar Mishra  1 , Srikanta Das  1 , Deepak Kumar Parida  1 , Mani Charan Satapathy  1
Affiliations
Case Reports

Cranio cervical tuberculous hypertrophic pachymeningitis

Satya Bhusan Senapati et al. Surg Neurol Int. .

Abstract

Background: Hypertrophic pachymeningitis is a unique clinical entity characterized by fibrosis and thickening of dura mater resulting in neurological dysfunction. It could be idiopathic or due to variety of inflammatory and infectious conditions. Tuberculous hypertrophic pachymeningitis involving cranio cervical region is rarely reported.

Case description: A 50-year-old female presented with history of progressive quadriparesis and stiffness of neck for 2 years, dysphagia to liquid for past 3 months. Her condition rapidly deteriorated when another physician prescribed her corticosteroid. Physical examination revealed high cervical compressive myelo-radiculopathy with lower cranial nerve palsy and neck rigidity. Series of serum analysis, cerebrospinal fluid (CSF) study and contrast magnetic resonance imaging (MRI) clinched the diagnosis. She improved on antitubercular treatment.

Conclusion: In case of multilevel cervical compressive myelo-radiculopathy with lower cranial involvement, possibility of hypertrophic pachymeningitis should be kept in mind. Before diagnosing it as idiopathic, infectious causes should be excluded otherwise prescription of corticosteroid will flare up the disease process.

Keywords: Cranio cervical; hypertrophic pachymeningitis; tuberculous.

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Figures

Figure 1
Figure 1
Sagittal T1- and T2-weighted MRI, showing hypointense hypertrophic pachymeninges extending from caudal aspect of posterior fossa up to C7 level with variable cord compression and myelomalacia
Figure 2
Figure 2
Sagittal T1-weighted image, showing curvilinear enhancement of the inner layer of thickened meninges following gadolinium administration
Figure 3
Figure 3
Axial T1-weighted MRI, showing circumferentially compressed cord along with nerve roots due to grossly hypertrophic pachymeninges
Figure 4
Figure 4
Axial T1-weighted MRI, showing enhancement of the inner layer of thickened meninges following gadolinium administration
See this image and copyright information in PMC

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