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Tuberculous Hypertrophic Pachymeningitis

Nikhil L Cordeiro1, Sushilkumar S Gupta2, Anubhav Kanwar3

  • 1Cardiology, Maimonides Medical Center, Brooklyn, USA.

Cureus
|September 13, 2021
PubMed

Insights

Tuberculous pachymeningitis, a rare condition causing dural thickening, can present with chronic headaches and neurological deficits. Early diagnosis and antitubercular treatment lead to significant symptom improvement and MRI resolution.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Radiology

Background:

  • Tuberculous pachymeningitis is an uncommon manifestation of tuberculosis affecting the dura mater.
  • It often presents with nonspecific symptoms like chronic headaches and focal neurological deficits.

Observation:

  • A 62-year-old male presented with chronic headaches, progressive vision and hearing loss, and dysphagia.
  • Magnetic resonance imaging (MRI) revealed dural thickening.
  • Cerebrospinal fluid analysis showed lymphocytic pleocytosis with elevated protein.

Findings:

  • Dural biopsy confirmed necrotizing granulomas with Langhans giant cells, indicative of tuberculosis.
  • The patient demonstrated a positive clinical response to antitubercular therapy and steroids.
  • Follow-up MRI at 24 months showed near-complete resolution of meningeal enhancement.

Implications:

  • This case highlights the importance of considering tuberculosis in the differential diagnosis of pachymeningitis, even in non-endemic areas.
  • Prompt diagnosis and treatment of tuberculous pachymeningitis can lead to favorable neurological outcomes.
  • Antitubercular treatment combined with steroids is an effective management strategy for this rare condition.
Keywords:
brain awarenesscranialduraduralenhancementhypertrophicpachymeningitisthickeningtuberculosis

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