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[A case of hypertrophic cranial pachymeningitis developed skull lesion]
S Mizumatsu1, H Michiue, M Suga
1Department of Neurological Surgery, Matsuyama Shimin Hospital, 2-6-5 Ohte-machi, Matsuyama, Ehime 790-0067, Japan.
Abstract:
We report a case of hypertrophic cranial pachymeningitis (HCP) developed skull lesion. A 70-year-old male presented with the symptom of left hemiconvulsion. MRI revealed that the enhanced intraosseous mass infiltrated into the the dura and brain parenchyma under the parasagittal region of the right parietal bone. Histological examination revealed chronic inflammation with lymphoplasmacytic infiltrate and fibrosis of both intraosseous mass and dural invasive lesion. Steroid therapy resulted in improvement of clinical symptoms and enhanced lesion of MRI. Three years later, the patient presented with generalized convulsion and weakness of right upper and lower limbs. MRI revealed dural thickening with gadolinium enhancement in the bilateral parasagittal region and falx. Angiography showed occlusion of the superior sagittal sinus. The cause of relapsing symptoms in this patient may have been related to the occlusion of the superior sagittal sinus, due to HCP. We considered that the incipient intraosseous mass resulted from a response of the marrow by destructive progression of chronic inflammation passed through the fracture crack or the cavity of arachnoid granulation.
Insights
Hypertrophic cranial pachymeningitis (HCP) can cause skull lesions and dural thickening. This case highlights HCP
Area of Science:
- Neurology
- Pathology
Background:
- Hypertrophic cranial pachymeningitis (HCP) is a rare condition characterized by chronic inflammation and thickening of the dura mater.
- Skull base and intracranial lesions are uncommon manifestations of HCP.
Observation:
- A 70-year-old male presented with hemiconvulsion, revealing an enhanced intraosseous mass infiltrating the dura and brain parenchyma.
- Histopathology confirmed chronic inflammation with lymphoplasmacytic infiltrate and fibrosis.
- Three years later, the patient experienced relapse with generalized convulsions and limb weakness, associated with dural thickening and superior sagittal sinus occlusion.
Findings:
- Steroid therapy initially improved symptoms and MRI findings.
- Relapse was linked to superior sagittal sinus occlusion, potentially caused by HCP progression.
- The intraosseous mass may have arisen from chronic inflammation extending into the bone marrow.
Implications:
- This case expands the understanding of rare skull manifestations of hypertrophic cranial pachymeningitis.
- It underscores the importance of considering HCP in the differential diagnosis of intracranial masses and sinus occlusions.
- The findings suggest a potential mechanism for bone marrow involvement in chronic dural inflammation.