Idiopathic hypertrophic cranial pachymeningitis misdiagnosed as acute subtentorial hematoma.

Abstract

A case of idiopathic hypertrophic cranial pachymeningitis (IHCP) misdiagnosed as an acute subdural hematoma is reported. A 37-year-old male patient presented with headache following head trauma 2 weeks earlier. Computerized tomography showed a diffuse high-density lesion along the left tentorium and falx cerebri. Initial chest X-rays revealed a small mass in the right upper lobe with right lower pleural thickening, which suggested lung cancer, such as an adenoma or mediastinal metastasis. During conservative treatment under the diagnosis of a subdural hematoma, left cranial nerve palsies were developed (3rd and 6th), followed by scleritis and uveitis involving both eyes. Magnetic resonance imaging (MRI) revealed an unusual tentorium-falx enhancement on gadolinium-enhanced T1-weighted images. Non-specific chronic inflammation of the pachymeninges was noticed on histopathologic examination following an open biopsy. Systemic steroid treatment was initiated, resulting in dramatic improvement of symptoms. A follow-up brain MRI showed total resolution of the lesion 2 months after steroid treatment. IHCP should be included in the differential diagnosis of subtentorial-enhancing lesions.

• Authors: Ik-Seong Park, Hoon Kim, Eun Yong Chung, Kwang Wook Cho
• Journal: Journal of Korean Neurosurgical Society (J Korean Neurosurg Soc) Vol. 48 Issue 2 Pg. 181-4 (Aug 2010) ISSN: 1598-7876 [Electronic] Korea (South)
• PMID: 20856672 (Publication Type: Case Reports)