Korean J Clin Neurophysiol.  2016 Jun;18(1):11-13. 10.14253/kjcn.2016.18.1.11.

Idiopathic Hypertrophic Cranial Pachymeningitis Masquerading as Tolosa-Hunt Syndrome

• Kim DH
• Hwang YS
• Lee HS
• Park HY

• KMID: 2328822
• DOI: http://doi.org/10.14253/kjcn.2016.18.1.11

Abstract

Idiopathic hypertrophic cranial pachymeningitis (ICHP) is diffuse inflammatory process of the dura mater. ICHP can produce similar presentation with Tolosa-Hunt syndrome (THS) if it involves cavernous sinus. A-29-year old male with persistent headache and no definite neurologic dysfunction was noted. Two weeks later, he complained of ophthalmoplegia, and his symptoms were thought to be manifestations of THS. Brain magnetic resonance images revealed diffuse thickened, enhanced pachymeninges in left tentorium. The patient was diagnosed with IHCP. We report a IHCP patient who showed very similar presentation as THS.

Keyword

Pachymeningitis; Tolosa-Hunt syndrome; Ophthalmoplegia

MeSH Terms

Brain
Cavernous Sinus
Dura Mater
Headache
Humans
Male
Meningitis*
Neurologic Manifestations
Ophthalmoplegia
Tolosa-Hunt Syndrome*

Figure

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  Figure 1. Brain MRI of patient. T1-and T2-weighted images reveled mild bulging soft tissues in the left cavernous sinus left cavernous sinus (A). Enhanced T1 weighted image show a thickening and enhancement of the left cavernous sinus and superior orbital fissure (B), and of the left tentorium (C). Three weeks later, abnormal enhancement is visible in the facial nerve (arrow), suggesting inflammatory facial nerve disease in T1-weighted images (D).

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