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2.1
Spinal Pachymeningitis
Pachymeningitis Spinal

Presentation

We present 2 cases of this condition with a description of MR imaging findings. [ajnr.org]

Depending upon the level involved and degree of spinal canal stenosis, the patient may present with single or multi-level radiculopathy and myelopathy. Our patients also presented with radiculopathy and myelopathic symptoms. [annalsofian.org]

CASE REPORT A 28 year old female presented with weakness of all extremities. She noted the onset of symptoms after a MI, one month prior to presentation at our institution. She hyperextended her neck during the fall. [ajns.paans.org]

We report a child with chronic tuberculous pachymeningitis, who presented with clinical manifestations of meningitis with a compatible cerebrospinal fluid analysis. [brieflands.com]

Idiopathic hypertrophic pachymeningitis presenting with occipital neuralgia. Afr Health Sci 2015 15:302-306. PMID: 25834565. 3. Bosman T, Simonin C, Launay D, Caron S, DestĂŠe A, Defebvre L. [e-neurospine.org]

Neurologic

  • Cranial Nerve Involvement

    Cranial nerve VIII is the most commonly involved cranial nerve, followed by CN V, VII, IX, X, and XII, with equal frequency [ 4 ]. [omicsonline.org]

    involvement and helped us to arrive at a plausible diagnosis explaining the noncontiguous cranial nerve involvement and excluded diabetic neuropathy. [jcor.in]

    Lower cranial nerves were chiefly involved in two patients whereas optic nerve was the predominantly affected nerve in one. [neurologyindia.com]

    Besides, cranial nerve palsy was another common symptom in HP, particularly of the optic nerve, auditory nerve, and abductor nerve in this study, which were associated with involvement of the dura surrounding the intracranial optic nerve and the cavernous [hindawi.com]

    nerve palsies with decreased sensation in the right V cranial nerve distribution. [annalsofian.org]

  • Papilledema

    Clinical features include headache, cranial nerve impairment, paraparesis or tetraparesis, ataxia, hydrocephalus, papilledema, hemorrhage or secondary vascular occlusions (5). [path.upmc.edu]

    Other neurologic symptoms of IHP include cranial nerve palsies (cranial nerves IV–VIII), cerebellar ataxia, seizures, and neuroophthalmic symptoms such as visual field loss, complete blindness, optic neuropathy, and increased intracranial pressure with papilledema [pubs.rsna.org]

    Her left optic disk was atrophic and there was papilledema on the right eye. Another MRI was performed and showed the same pattern of meningeal enhancement seen on the first one. [scielo.br]

  • Clonus

    Neurological examination showed bilateral ankle clonus and mute bilateral plantar reflex. [annalsofian.org]

    Ankle clonus, Hoffmann sign, Babinski sign, and Chaddock sign were positive for bilateral extremities. On the second day after admission, the lower extremity weakness was exacerbated. [frontiersin.org]

  • Bilateral Ankle Clonus

    Neurological examination showed bilateral ankle clonus and mute bilateral plantar reflex. [annalsofian.org]

Workup

Diagnosing the primary cause is crucial for optimal management, which usually requires extensive clinical and laboratory workup. [annalsofian.org]

Case details (continued) The further workup revealed a HIV virus load of 198,322 and CD4 count of 281 cells/μL (normal range: 490-1740 cells/μL). Tuberculin skin test reading was positive 8 mm. [jpgmonline.com]

[…] fibrosis. [14] Chronic periaortitis had been recognized as a common manifestation of IgG4RD, and it commonly affects abdominal aorta; it often coexists with autoimmune pancreatitis, another prototype manifestation of this disease. [15] In the diagnostic workup [indianjrheumatol.com]

Treatment

Early identification and treatment of underlying diseases like vasculitis, IgG4, Behcets and malignancies might improve treatment outcomes and prevent systemic complications. [annalsofian.org]

Most patients improve after decompressive surgery; however, continued progression after surgical treatment has been reported. [ajns.paans.org]

Spinal canal decompression and autogenous bone grafting are accepted treatments in the young patient. Careful observation of the patient to watch for local progression is necessary. [u-toyama.elsevierpure.com]

Prognosis

The prognosis of idiopathic HSP with positive inflammatory signs may be worse; the authors stress the significance of early surgical treatment. [ncbi.nlm.nih.gov]

According to a review of the English and Japanese literature on idiopathic HSP, the prognosis of patients with positive inflammatory signs is worse than that of those with no inflammatory signs. [scienceopen.com]

Treatment and Prognosis All cases were treated with corticosteroids. [hindawi.com]

Etiology

On the basis of the etiology, pachymeningitis can be idiopathic or secondary, associated with various other etiologies like infection, inflammation, granulomatous or neoplastic disorders. [annalsofian.org]

Syphilis and tuberculosis have been considered the chief etiological agents in this disease, the former being by far... Bibliography HASSIN GB: Circumscribed suppurative (non-tuberculous) peripachymeningitis. Histopathologic study of a case, Arch. [acpjournals.org]

A number of etiologies have been attributed to its development including infection (tuberculosis, fungi, syphilis); however, in most cases the cause of spinal pachymeningitis is vague or idiopathic. [ajns.paans.org]

Although many associated diseases have been suggested, the etiology of IHSP is not well understood. The ideal treatment is controversial. [jkns.or.kr]

Epidemiology

In epidemiology, it may be used to analyze a closely grouped series of events or cases of disease or other health-related phenomenon with well-defined distribution patterns in relation to time or place or both. [bioportfolio.com]

The epidemiology and pathogenesis of IgG4-RHP are poorly un-derstood. [docslide.com.br]

However, until now, no large-scale epidemiological data have been made available worldwide. IgG4-related diseases usually affect elderly patients (>50 years), with a significant male predominance (11, 15). [frontiersin.org]

Epidemiology Pachymeningitis is most often found in infants and in middle-aged men. [iliveok.com]

Epidemiology of sarcoidosis in the Isle of Man: evidence for space time clustering. Thorax 1987;42:427-430. [ Links ] 27. Kern DG, Neil MA, Wrenn DS, Varone JC. Investigation of an unique time-space cluster of sarcoidosis in firefighters. [scielo.br]

Pathophysiology

Abstract In pathophysiology and clinical practice, the intracranial pressure (ICP) profiles in the supratentorial and infratentorial compartments are unclear. [ncbi.nlm.nih.gov]

A1/A2 (Leu33Pro), a single nucleotide polymorphism (SNP) at position 196 in the beta 3 integrin gene, is most thoroughly investigated for its potential pathophysiological role in CAD. [cureus.com]

Prevention

Idiopathic HSP is a clinical emergency and early surgical intervention is essential to prevent irreversible damage to the nervous system. [jstage.jst.go.jp]

Early identification and treatment of underlying diseases like vasculitis, IgG4, Behcets and malignancies might improve treatment outcomes and prevent systemic complications. [annalsofian.org]

Idiopathic HSP is a clinical emergency and early surgical intervention is essential to prevent irreversible damage to the nervous system. [Indexed for MEDLINE] Free full text [ncbi.nlm.nih.gov]

Early surgical intervention with postoperative corticosteroid therapy is a known treatment for this disease, as a way to prevent irreversible neurological damage. [pubmed.ncbi.nlm.nih.gov]

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