title: Granulomatosis with polyangiitis presenting with pachymeningitis.
abstract: METHODS
  This case report describes a 75 year-old Caucasian male who initially presented with persistent daily headaches. Physical exam elicited multiple cranial nerve palsies. Gadolinium-enhanced brain MRI demonstrated pachymeningitis. Labs revealed elevated proteinase-3 antineutrophil cytoplasmic antibodies (PR3-ANCA) and cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCA), confirming a diagnosis of GPA.
  
  
  CONCLUSIONS
  GPA should be considered in older patients presenting with persistent daily headaches and pachymeningitis. Contrast-enhanced brain MRI is an important diagnostic tool.
authors: Wake Forest School of Medicine, United States.
authors: Nasarachi E
authors: NE
authors: Onyeuku
authors: Department of Neurology, Wake Forest School of Medicine, United States. Electronic address: nbalakri@wakehealth.edu.
authors: Nikhil
authors: N
authors: Balakrishnan
authors: Department of Neurology, Wake Forest School of Medicine, United States.
authors: Michael S
authors: MS
authors: Cartwright
mesh_terms: D000368:Aged; D014890:Granulomatosis with Polyangiitis / Q000150:complications*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008581:Meningitis / Q000150:complications*
keywords: Cranial neuropathy; Granulomatosis with polyangiitis; Headache; MRI; Pachymeningitis; Wegener's granulomatosis