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Journal of Korean Neurosurgical Society 2010;48(2): 181-184.
doi: https://doi.org/10.3340/jkns.2010.48.2.181
Idiopathic Hypertrophic Cranial Pachymeningitis Misdiagnosed as Acute Subtentorial Hematoma.
Ik Seong Park, Hoon Kim, Eun Yong Chung, Kwang Wook Cho
1Department of Neurosurgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea. jkw94@naver.com
2Department of Anethesiology and Pain Medicine, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea.
ABSTRACT
A case of idiopathic hypertrophic cranial pachymeningitis (IHCP) misdiagnosed as an acute subdural hematoma is reported. A 37-year-old male patient presented with headache following head trauma 2 weeks earlier. Computerized tomography showed a diffuse high-density lesion along the left tentorium and falx cerebri. Initial chest X-rays revealed a small mass in the right upper lobe with right lower pleural thickening, which suggested lung cancer, such as an adenoma or mediastinal metastasis. During conservative treatment under the diagnosis of a subdural hematoma, left cranial nerve palsies were developed (3rd and 6th), followed by scleritis and uveitis involving both eyes. Magnetic resonance imaging (MRI) revealed an unusual tentorium-falx enhancement on gadolinium-enhanced T1-weighted images. Non-specific chronic inflammation of the pachymeninges was noticed on histopathologic examination following an open biopsy. Systemic steroid treatment was initiated, resulting in dramatic improvement of symptoms. A follow-up brain MRI showed total resolution of the lesion 2 months after steroid treatment. IHCP should be included in the differential diagnosis of subtentorial-enhancing lesions.
Key Words: Pachymeningitis; Subtentorial hematoma; Lower cranial nerve palsy
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