Acute pachymeningitis mimicking subdural hematoma in a patient with polyarteritis nodosa.
Pachymeningitis is a very rare neurologic manifestation of polyarteritis nodosa (PAN). This report describes a case of acute pachymeningitis that was, initially, misdiagnosed as subdural hematoma on the brain CT of a patient with PAN. A 45-year-old man, who had been diagnosed as having PAN 6 months previously, came back to the emergency room with complaints of sudden headache, nausea, vomiting, and diplopia for 3 days before his hospital admission. Initially, the noncontrast enhanced brain CT findings showed high densities in the bilateral tentorial and posterior parafalcial area, which suggested a small amount of subdural hematoma. However, the subsequent MRI findings revealed pachymeningitis of the bilateral tentoria and falx. He was treated with high-dose steroid and cyclophosphamide pulse therapy. Thereafter, his symptoms gradually resolved.
Song
Jung-Soo
JS
Department of Rheumatology/Medicine, Chung-Ang University School of Medicine, 7-206, 3-Ga, Shinhung-dong, Jung-Gu, Incheon, 400-711, South Korea.
Lim
Myung-Kwan
MK
Park
Bo-Hyoung
BH
Park
Won
W
D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D006408:Hematoma, Subdural / Q000175:diagnosis; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008581:Meningitis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D008875:Middle Aged; D010488:Polyarteritis Nodosa / Q000150:complications*; D020551:Pulse Therapy, Drug; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D003520:Cyclophosphamide