Hypertrophic cranial pachymeningitis associated with middle ear inflammation.
OBJECTIVE
To describe a series of patients with hypertrophic cranial pachymeningitis (HCP) associated with chronic middle ear inflammation.


METHODS
Retrospective case review.


METHODS
University Hospital.


METHODS
Six consecutive patients between the years 2000 and 2004 who had both middle ear disease and HCP (three men and three women; age range, 36-72 yr, mean age, 58.2 yr). The diagnosis of HCP was made by the use of contrast-enhanced magnetic resonance imaging scans of the brain in all patients.


METHODS
Contrast-enhanced magnetic resonance imaging (MRI) of the brain, dural biopsy, and otomicroscopic examination.


METHODS
Thickening and abnormal enhancement of the dura mater on the MRI of the brain.


RESULTS
All of the six patients had chronic inflammatory middle ear diseases. Three patients had otitis media with effusion, two had chronic otitis media, and one had postoperative otorrhea. The most common presentations of HCP were headache and cranial nerve palsies. Cranial Nerves V and VIII were the most frequently involved. On contrast-enhanced MRI examination of the brain, an enhancement of the dura mater was observed on the same side as the middle ear diseases in five of the six patients, whereas bilateral enhancement was observed in one patient. Corticosteroid therapy was effective for alleviating the symptoms in all six patients.


CONCLUSIONS
Chronic middle ear inflammation might be involved in the pathogenesis of HCP, probably mediated by the venous return.
Iwasaki
Shinichi
S
Department of Otolaryngology, Faculty of Medicine, University of Tokyo, Tokyo, Japan. iwashin-tky@umin.ac.jp
Ito
Ken
K
Sugasawa
Masashi
M
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003391:Cranial Nerves / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008581:Meningitis / Q000209:etiology*; D008875:Middle Aged; D010033:Otitis Media / Q000150:complications* / Q000503:physiopathology; D010808:Physical Examination; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed