Related Experiment Video

Updated: Aug 5, 2026

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

Published on: January 17, 2018

Idiopathic Hypertrophic Pachymeningitis Presenting as Cavernous Sinus Syndrome Mimicking Orbital Apex Pathology: A

¹Critical Care Department, Vijaya Viva Hospital, Kottarakara, Kollam, IND.

|July 31, 2026

Abstract:

Idiopathic hypertrophic pachymeningitis (IHP) is a rare chronic fibro-inflammatory disorder characterized by localized or diffuse thickening of the dura mater. Because its clinical and radiological manifestations overlap with infectious, autoimmune, neoplastic, and vascular disorders, diagnosis is often challenging. We report a 43-year-old woman who presented with progressive left frontotemporal headache followed by diplopia, ptosis, facial numbness, and ophthalmoplegia. Neurological examination localized the lesion to the left cavernous sinus region. Contrast-enhanced magnetic resonance imaging demonstrated enhancing dural thickening involving the left cavernous sinus and adjacent temporal dura. Extensive investigations excluded infectious, neoplastic, and autoimmune etiologies. A diagnosis of IHP was established after multidisciplinary evaluation. The patient demonstrated significant clinical improvement following corticosteroid therapy. This case highlights the importance of early magnetic resonance imaging, careful neuroanatomical localization, and systematic exclusion of secondary causes when evaluating painful cranial neuropathies.

Keywords:

cavernous sinus cranial neuropathy dural thickening headache with neurological deficits idiopathic hypertrophic pachymeningitis immunosuppression ophthalmoplegia orbital epex syndrome steroid dependent steroid therapy

Related Concept Videos

Brain Abscess l: Introduction

Brain Abscess l: Introduction

A brain abscess is a focal, intracerebral infection characterized by a localized collection of pus within the brain parenchyma, resulting from microbial invasion and the body’s inflammatory response. It progresses through stages: early and late cerebritis, followed by early and late capsule formation, reflecting tissue destruction, immune response, and eventual encapsulation.Etiology and PathogenesisCausative organisms vary with source and host factors, often involving polymicrobial infections,...

Glaucoma: Overview

Glaucoma: Overview

Glaucoma is an eye condition characterized by increased intraocular pressure that damages the retina and optic nerve, leading to irreversible blindness if left untreated. The human eye has various components, including the cornea, iris, pupil, lens, and optic nerve. Aqueous humor is secreted by the epithelium of the ciliary body in the posterior chamber and flows through the trabecular meshwork and canal of Schlemm, maintaining normal intraocular pressure. The trabecular meshwork and the canal...

Increased Intracranial Pressure l: Introduction

Increased Intracranial Pressure l: Introduction

Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component expands, CSF and venous blood...

Cerebral Edema ll: Pathophysiology

Cerebral Edema ll: Pathophysiology

Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this barrier loses...

Increased Intracranial Pressure ll: Pathophysiology

Increased Intracranial Pressure ll: Pathophysiology

Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...

Bacterial Meningitis II: Pathophysiology

Bacterial Meningitis II: Pathophysiology

Bacterial meningitis typically begins when pathogens such as Neisseria meningitidis and Streptococcus pneumoniae colonize the nasopharynx and invade the bloodstream. This process is facilitated by bacterial virulence factors, such as polysaccharide capsules, which resist phagocytosis and complement-mediated killing. Less commonly, bacteria reach the central nervous system via contiguous spread from infections like otitis media or sinusitis, through congenital or acquired dural defects, or...

Keywords:

cavernous sinus cranial neuropathy dural thickening headache with neurological deficits idiopathic hypertrophic pachymeningitis immunosuppression ophthalmoplegia orbital epex syndrome steroid dependent steroid therapy

Articles linked to this work by shared authors, journal, and citation graph.

Isolated Pupil-Sparing Third Nerve Palsy Revealing Cryptococcal Meningitis in a Patient With Diabetes Mellitus: A Diagnostic Pitfall.

Cureus·2026

See all related articles