A case of hypertrophic pachymeningitis with symptomatic venous congestion due to sinus stenosis

Sho Umegaki, Shin Ichiro Osawa, Kensuke Kimura, Toshimi Okushima, Nobuhisa Yajima, Tsuyoshi Kawamura, Teiji Tominaga

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

We report a patient with hypertrophic pachymeningitis and symptomatic stenosis of the superior sagittal sinus. A 71-year-old man presented with right hemiparesis, sensory-dominant aphasia, and right hemispatial neglect that had been worsening over 2 weeks. Computed tomography showed isodense crescent-shaped lesions deforming the surface of the left cerebral hemisphere, mimicking a subdural hematoma with atypical perifocal edema in the left parietal lobe. Magnetic resonance imaging showed diffuse thickening of the dura mater with contrast enhancement of his left cerebral hemisphere. Histopathological examination of the dural specimen obtained by burr-hole surgery revealed mononuclear inflammatory cell infiltration, and he was diagnosed with hypertrophic pachymeningitis. Dynamic cerebral angiography showed superior sagittal sinus stenosis with reduced venous flow through the left parietal lobe. Administration of high-dose steroid therapy led to neurological improvement. In the case of a subdural mass with atypical parenchymal edema such as a chronic subdural hematoma, other etiology should be taken into consideration.

Original languageEnglish
Pages (from-to)147-152
Number of pages6
JournalNeurological Surgery
Volume46
Issue number2
Publication statusPublished - 2018 Feb

Keywords

  • Chronic subdural hematoma
  • Hypertrophic pachymeningitis
  • Sinus stenosis
  • Venous congestion

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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