Idiopathic hypertrophic cranial pachymeningitis: clinicoradiological spectrum and therapeutic options.
OBJECTIVE
Idiopathic hypertrophic cranial pachymeningitis is a rare disease, of undetermined pathogenesis, that is characterized by inflammation and fibrosis of the dura mater.


METHODS
We encountered six patients with idiopathic hypertrophic cranial pachymeningitis and analyzed their clinical presentations, radiological findings, and treatment.


RESULTS
In the six patients, the main manifestations were cranial nerve palsies and headache. Three associations were present, namely optic neuropathy, Tolosa-Hunt syndrome, and diabetes insipidus. Gadolinium-enhanced magnetic resonance imaging was diagnostic, showing intense dural enhancement in a linear or nodular pattern. The responses to corticosteroid therapy were better for patients who exhibited linear, rather than nodular, dural enhancement. For one patient, surgical decompression of the superior orbital fissure provided lasting relief. The course of the disease followed one of three patterns, i.e., sustained remission, relapse with corticosteroid independence, or relapse with corticosteroid dependence. Pulse corticosteroid therapy provided significant relief, while reducing the daily corticosteroid requirement and avoiding side effects, for a corticosteroid-dependent relapsing patient.


CONCLUSIONS
Idiopathic hypertrophic cranial pachymeningitis exhibits varied clinical courses. It is important to prevent irreversible cranial neuropathy during the active phase of the disease, using daily administration of corticosteroids, pulse corticosteroid therapy, or surgical decompression.
Hatano
N
N
Department of Neurosurgery, Nagoya University School of Medicine, Japan.
Behari
S
S
Nagatani
T
T
Kimura
M
M
Ooka
K
K
Saito
K
K
Yoshida
J
J
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000368:Aged; D003937:Diagnosis, Differential; D004388:Dura Mater / Q000473:pathology; D005260:Female; D006801:Humans; D006984:Hypertrophy; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging; D008297:Male; D008581:Meningitis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D008875:Middle Aged; D009460:Neurologic Examination
D000305:Adrenal Cortex Hormones