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Idiopathic chronic hypertrophic pachymeningitis causing thoracic cord compression
1Postgraduate Institute of Neurological Surgery, Dr A Lakshmipathi Neurosurgical Centre, VHS Hospital, Chennai, India. neuro_sridhar@hotmail.com
British Journal of Neurosurgery
|April 1, 2005
Summary
Chronic idiopathic pachymeningitis, a rare cause of spinal cord compression, presents diagnostic challenges. Surgical decompression and empirical anti-tubercular therapy led to neurological improvement in a patient with thoracic myelopathy.
Area of Science:
- Neurology
- Neurosurgery
- Pathology
Background:
- Chronic idiopathic pachymeningitis is a rare condition causing spinal cord compression due to dural thickening.
- It can lead to neurological deficits through direct pressure or vascular compromise.
Observation:
- A 48-year-old female presented with progressive spastic paraparesis.
- MRI revealed a hypointense extradural band compressing the thoracic spinal cord from C7 to T11.
- CT scans and myelography failed to identify the cause.
Findings:
- Surgical exploration (T1-T10 laminectomy) revealed hypertrophied dura compressing the spinal cord.
- Histopathology confirmed pachymeningitis.
- Post-operative decompression resulted in neurological improvement.
Implications:
- This case highlights diagnostic challenges in spinal cord compression due to pachymeningitis.
- Surgical decompression is crucial for symptom relief.
- Empirical anti-tubercular therapy may be considered despite negative serology.