J Korean Neurosurg Soc.  2010 Aug;48(2):181-184. 10.3340/jkns.2010.48.2.181.

Idiopathic Hypertrophic Cranial Pachymeningitis Misdiagnosed as Acute Subtentorial Hematoma

• Park IS
• Kim H
• Chung EY
• Cho KW

• KMID: 2138400
• DOI: http://doi.org/10.3340/jkns.2010.48.2.181

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.

Keyword

Pachymeningitis; Subtentorial hematoma; Lower cranial nerve palsy

MeSH Terms

Adenoma
Adult
Biopsy
Brain
Cranial Nerve Diseases
Craniocerebral Trauma
Diagnosis, Differential
Eye
Follow-Up Studies
Headache
Hematoma
Hematoma, Subdural
Hematoma, Subdural, Acute
Humans
Inflammation
Lung Neoplasms
Magnetic Resonance Imaging
Male
Meningitis
Neoplasm Metastasis
Scleritis
Thorax
Uveitis