Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Idiopathic Hypertrophic Cranial Pachymeningitis Misdiagnosed as Acute Subtentorial Hematoma

  • Park, Ik-Seong (Department of Neurosurgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Hoon (Department of Neurosurgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Chung, Eun-Yong (Department of Anethesiology and Pain Medicine, St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Cho, Kwang-Wook (Department of Neurosurgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2010.01.22
  • Accepted : 2010.08.03
  • Published : 2010.08.28
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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.

Keywords

References

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