[A case of hypertrophic spinal pachymeningitis]

A 79-year-old woman was admitted to our hospital complaining of gait disturbance. At the time of admission, she had incomplete monoparesis of the left lower extremity, with a sensory level of T6. MR images showed a thickened dura at the C6-T4 vertebral levels. The thickened dura showed low intensities on T1- and T2-weighted images, and was homogeneously enhanced by Gd-DTPA. Hypertrophic spinal pachymeningitis (HSP) was suspected, and laminectomy was performed from T2 to T3. The thickened dura was found and partially resected. Microscopically, the diagnosis was HSP. Steroid therapy was initiated after surgery. Postoperatively, the patient's physical status and radiographic images improved. The etiology of HSP is not clear in most cases. It is difficult to diagnose radiographically, although MR imaging can help differentiate it from other disorders. T1- and T2-weighted images of HSP show low intensities, and the T1-weighted image is homogeneously enhanced by Gd-DTPA. Treatment is early decompressive surgery with possible excision of the involved dura. Steroid therapy was effective in our case.