From the Department of Neurology, The Pennsylvania State University Milton S. Hershey Medical Center College of Medicine.
Address correspondence and reprint requests to Dr. Max R. Lowden, Department of Neurology, The Pennsylvania State University Milton S. Hershey Medical Center, 30 Hope Drive, Hershey, PA 17033 Mlowden{at}hmc.psu.edu
A 42-year-old woman had progressive numbness from both feetto mid chest for 2 weeks. Examination showed a sensory levelat T8, no weakness, and brisk reflexes throughout.
MRI showed T2–T5 dural thickening (figure 1). Testingrevealed an elevated sedimentation rate and normal chest x-ray,CSF analyses, and tests for rheumatologic diseases and infections.Dural biopsy showed an inflammatory infiltrate (figure 2).
Figure 1 Sagittal and axial MRI T2-weighted images
(A) Sagittal MRI T2-weighted image showing a dural lesion of low signal intensity within the spinal canal at levels T2 to T5 extending anteriorly. (B) Axial MRI T2-weighted image at T3 and T4 level showing a dural mass (white arrow) in the anterior aspect of the spinal canal.
Figure 2 Hematoxylin and eosin stain of dural mass showing a chronic inflammatory infiltrate consisting of plasma cells and lymphocytes
There is also fibrosis and reactive fibroblasts throughout.
Idiopathic hypertrophic pachymeningitis is a diagnosis of exclusionsince it is associated with trauma, infection, and autoimmunediseases. Treatment consists of corticosteroids and steroidsparing agents.1 It is usually found intracranially and rarelyinvolves cervical and higher thoracic levels.2
Kupersmith MJ, Martin V, Heller G, Shah A, Mitnick HS. Idiopathic hypertrophic pachymeningitis. Neurology 2004;62:686–694.[Abstract/Free Full Text]
Pai S, Welsh CT, Patel S, Rumboldt Z. Idiopathic hypertrophic spinal pachymeningitis: report of two cases with typical MR imaging findings. Am J Neuroradiol 2007;28:590–592.[Abstract/Free Full Text]
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