PDF(Pubmed)
Abstract：
Introduction and importance Hypertrophic pachymeningitis (HP) is an uncommon disorder with varied etiological origins and heterogeneous clinical presentation. Establishing the etiological diagnosis poses a challenge, but prompt identification provides a treatment window, potentially leading to a reversal of symptoms. MRI is the reference examination, allowing not only the early diagnosis of pachymeningitis but also the assessment of its extent and importance, detection of possible complications, and suggestion of etiology. Case presentation We conducted a retrospective study involving 24 patients recruited over 5 years for who brain imaging had revealed the presence of pachymeningitis. The average age of the patients was 40 years, with a male-to-female ratio of 0.6. Clinical discussion Headache was present in 54.17% of patients. All the patients underwent MRI examinations utilizing different sequences, with subsequent Gadolinium injection showing localized and asymmetrical meningeal thickening in 13 cases, and diffuse in the rest. The cerebrospinal fluid study unveiled an inflammatory fluid characterized by a lymphocytic predominance and hyperproteinorrhea, noted in 50% of the patients. The histopathological analysis of a stereotactic biopsy conducted on an individual patient revealed non-diagnostic results. The etiological investigation was dominated by tuberculosis, which was detected in 33.3% of cases. Idiopathic origin was identified in 16.7% of patients. Conclusion Meningeal thickening is rare, and the multitude of potential causes makes the etiological investigation challenging unless they fall within the scope of secondary meningeal disorders; otherwise, a dural biopsy becomes necessary, and the prompt initiation of treatment, along with determining the etiology influences the prognosis.
摘要：
简介和重要性肥厚性硬脑膜炎（HP）是一种罕见的疾病，具有多种病因和异质性临床表现。建立病因诊断提出了挑战，但是快速识别提供了一个治疗窗口，可能导致症状逆转。MRI是参考检查,不仅可以早期诊断硬脑膜炎，还可以评估其程度和重要性，检测可能的并发症，并提示病因。病例介绍我们进行了一项回顾性研究，涉及5年以上招募的24名患者，这些患者的脑影像学检查显示存在硬脑膜炎。患者平均年龄为40岁,男女比例为0.6。临床讨论54.17%的患者出现头痛。所有患者均采用不同序列进行MRI检查，随后注射钆显示13例局部和不对称脑膜增厚，并在其余部分扩散。脑脊液研究揭示了一种炎性液体，其特征是淋巴细胞占优势和蛋白质过多，在50％的患者中注意到。对单个患者进行的立体定向活检的组织病理学分析显示出非诊断结果。病原学调查以结核病为主，在33.3%的病例中检测到。在16.7％的患者中确定了特发性起源。结论脑膜增厚少见,和众多的潜在原因使得病因学调查具有挑战性，除非它们属于继发性脑膜疾病的范围内；否则，硬脑膜活检变得必要，并迅速开始治疗，随着病因的确定影响预后。
