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Case Reports
. 2021 Aug 30;13(8):e17570.
doi: 10.7759/cureus.17570. eCollection 2021 Aug.

Tuberculous Hypertrophic Pachymeningitis

Nikhil L Cordeiro  1 , Sushilkumar S Gupta  2 , Anubhav Kanwar  3 , Carolyn Bendor-Grynbaum  4 , Jyoti B Sharma  5
Affiliations
Case Reports

Tuberculous Hypertrophic Pachymeningitis

Nikhil L Cordeiro et al. Cureus. .

Abstract

Tuberculous pachymeningitis is a rare disease that should be suspected in patients with chronic headaches, focal neurological signs, and magnetic resonance imaging (MRI) findings of dural thickening. We report the case of a 62-year-old male who presented with chronic headaches for over a year, progressive right-sided vision and hearing loss for six months, and progressive dysphagia for a month. On investigation, MRI showed dural thickening, cerebrospinal fluid showed lymphocytic pleocytosis with high protein and normal glucose levels, and biopsy of the dural matter showed necrotizing granulomas with Langhans giant cells. The patient responded well to antitubercular treatment and steroids. Follow-up MRI 24 months later showed almost complete resolution of meningeal enhancement. Though tuberculosis is an uncommon cause of pachymeningitis, it should be considered, as it responds well to treatment.

Keywords: brain awareness; cranial; dura; dural; enhancement; hypertrophic; pachymeningitis; thickening; tuberculosis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Pretreatment: Post-gadolinium coronal T1-weighted MRI showing diffuse posterior dural enhancement. Arrows show dural enhancement.
MRI: magnetic resonance imaging
Figure 2
Figure 2. Posttreatment at 24 months: Post-gadolinium coronal T1-weighted MRI showing almost complete resolution of dural enhancement.
MRI: magnetic resonance imaging
See this image and copyright information in PMC

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