[Otogenic hypertrophic cranial pachymeningitis associated with edema of the temporal lobe and organic mental disorder-case report].
OBJECTIVE
Hypertrophic cranial pachymeningitis(HCP) is a rare disease which might be misdiagnosed. One typical case of otogenic hypertrophic cranial pachymeningitis (HCP) associated with edema of the temporal lobe and organic mental disorder was reported. Literatures associated with HCP were reviewed for reference.


METHODS
In July, 1997, a 26-year-old man was admitted for right-sided severe headache, dizziness, nausea, vomiting, facial and abducens nerve palsy. MRI and CT revealed inflammation in the temporal bone and locally thickened dura mater with obvious enhancement as a band in the petrous apex and nearby tentorium cerebellum. The patient then underwent operation including decompression of the facial nerve, labyrinthectomy, and eradication of the inflammatory cells in the mastoid and petrous portion. Postoperatively, the clinical signs disappeared except hearing loss. Seven months later, the patient suffered from mental disorder with interrupted excitement to hit and abuse the family members. He was then treated in a psychosis hospital but no improvement could be seen. On May 13, 1998, MRI and the enhanced MRI demonstrated diffuse thickened tentorium cerebellum and dura mater in the middle cranial fossa. The inferior portion of the temporal lobe was obvious edema. The internal carotid artery was partially occluded due to the thickened wall of cavernous sinus.


RESULTS
Hence, the diagnosis of HCP associated with edema of temporal lobe and organic mental disorder was established. The patient was cured by high dosage of penicillin.


CONCLUSIONS
MRI is an essential method for diagnosis of HCP. Antibiotic was an effective treatment.
Yi
Z
Z
Department of Otorhinolaryngology, First Affiliated Hospital, Fujian Medical University, Otorhinolaryngology Institute of Fujian Province, Fuzhou 350005, China. yizx@163.net
Zhang
R
R
Xiao
W
W
Lin
X
X
Lin
Y
Y
D000328:Adult; D001929:Brain Edema / Q000175:diagnosis / Q000209:etiology*; D004388:Dura Mater / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D006984:Hypertrophy; D008279:Magnetic Resonance Imaging; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D001523:Mental Disorders / Q000175:diagnosis / Q000209:etiology*; D010035:Otitis Media, Suppurative / Q000150:complications*; D013702:Temporal Lobe / Q000473:pathology