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We report seven patients with cranial pachymeningitis of unknown origin in whom the main clinical features were headaches,ataxia,and cranial nerve palsies.CSF showed inflammatory changes.CT and MRI showed thickening of the falx and of the tentorium.The clinical course was chronic.Four patients improved with prednisolone but became steroid dependent;in two cases,radiotherapy had no lasting improvement and in one,azathioprine permitted a reduction of the corticosteroids.Five patients had biopsy of the tentorium cerebelli or of the temporal dura mater.In two cases,autopsy revealed extensive pachymeningitis without parenchymal changes.In all instances,microscopic examination of the dura mater showed a cellular infiltrate of polymorphic cells;there were no epithelioid granulomas. Review of the literature discloses seven similar cases.We discuss the relationship of these lesions with inflammatory meningeal masses,the focal pachymeningitis of the Tolosa-Hunt syndrome,and multifocal fibrosis. |
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ataxia
CAT scan
CAT scan,abnormal
cranial nerve palsies
cranial neuropathy,multiple
headache
hypertrophic intracranial pachymeningitis
meningeal biopsy
MRI
MRI,abnormal
ophthalmoplegia
papilledema
sedimentation rate
sedimentation rate,elevated
tentorium cerebelli
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