Idiopathic hypertrophic cranial pachymeningitis successfully treated with weekly subcutaneous methotrexate.
Idiopathic hypertrophic cranial pachymeningitis is a very infrequent disorder. Adequate management is still a matter of debate. We describe the use of low-dose pulse methotrexate in treating a 63-year-old woman with idiopathic hypertrophic cranial pachymeningitis. A weekly scheme with subcutaneous methotrexate was tried. Clinical improvement occurred in one week. Total remission of the clinical and neuro-imaging abnormalities was evident 6 months later, with minimal side effects. The patient is in complete remission after one year of follow-up without treatment. Hence, low-dose weekly subcutaneous methotrexate may be safe and effective in inducing complete and sustained remission of this condition. The experience with subcutaneous methotrexate to treat this entity has never been reported.
Ruiz-Sandoval
J L
JL
Department of Neurology and Neurosurgery, Hospital Civil "Fray Antonio Alcalde", Universidad de Guadalajara, Guadalajara Jalisco, México. jorusan@mexis.com
Bernard-Medina
G
G
Ramos-Gómez
E J
EJ
Romero-Vargas
S
S
Gutiérrez-Ureña
S
S
González-Cornejo
S
S
Chiquete
E
E
D002526:Cerebellar Diseases / Q000209:etiology / Q000503:physiopathology; D003389:Cranial Nerve Diseases / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004388:Dura Mater / Q000187:drug effects* / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D020773:Headache Disorders / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D006984:Hypertrophy / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging; D008581:Meningitis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D008727:Methotrexate / Q000008:administration & dosage*; D008875:Middle Aged; D012074:Remission Induction; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D008727:Methotrexate