title: Cranio cervical tuberculous hypertrophic pachymeningitis.
abstract: BACKGROUND
  Hypertrophic pachymeningitis is a unique clinical entity characterized by fibrosis and thickening of dura mater resulting in neurological dysfunction. It could be idiopathic or due to variety of inflammatory and infectious conditions. Tuberculous hypertrophic pachymeningitis involving cranio cervical region is rarely reported.
  
  
  METHODS
  A 50-year-old female presented with history of progressive quadriparesis and stiffness of neck for 2 years, dysphagia to liquid for past 3 months. Her condition rapidly deteriorated when another physician prescribed her corticosteroid. Physical examination revealed high cervical compressive myelo-radiculopathy with lower cranial nerve palsy and neck rigidity. Series of serum analysis, cerebrospinal fluid (CSF) study and contrast magnetic resonance imaging (MRI) clinched the diagnosis. She improved on antitubercular treatment.
  
  
  CONCLUSIONS
  In case of multilevel cervical compressive myelo-radiculopathy with lower cranial involvement, possibility of hypertrophic pachymeningitis should be kept in mind. Before diagnosing it as idiopathic, infectious causes should be excluded otherwise prescription of corticosteroid will flare up the disease process.
authors.affiliation: Department of Neurosurgery, SCB Medical College and Hospital, Cuttack, Odisha, India.
authors.forename: Satya Bhusan
authors.initials: SB
authors.lastname: Senapati
authors.affiliation: Department of Neurosurgery, SCB Medical College and Hospital, Cuttack, Odisha, India.
authors.forename: Sudhansu Sekhar
authors.initials: SS
authors.lastname: Mishra
authors.affiliation: Department of Neurosurgery, SCB Medical College and Hospital, Cuttack, Odisha, India.
authors.forename: Srikanta
authors.initials: S
authors.lastname: Das
authors.affiliation: Department of Neurosurgery, SCB Medical College and Hospital, Cuttack, Odisha, India.
authors.forename: Deepak Kumar
authors.initials: DK
authors.lastname: Parida
authors.affiliation: Department of Neurosurgery, SCB Medical College and Hospital, Cuttack, Odisha, India.
authors.forename: Mani Charan
authors.initials: MC
authors.lastname: Satapathy
keywords: Cranio cervical; hypertrophic pachymeningitis; tuberculous