Hypertrophic Spinal Pachymeningitis with Special Reference to Appropriate Surgical Treatment

Pc, Bucy; Lw, Freeman

doi:10.3171/jns.1952.9.6.0564

Cited by 22 publications

(15 citation statements)

References 3 publications

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“…Linear dural enhancement pattern was known to have better response to steroid therapy than those with nodular pattern because of its less fibrosis and more vascularity 1,3,8,10,12,13) . The typical pathologic features are a thickening of the dura, with nonnecrotizing chronic inflammatory infiltrate of lymphocytes, plasma cell, and, occasionally with histiocytes, giant cells, polymorphonuclear cells or eosinophils 2,3,5,9,14) . In our cases, typical radiologic and pathologic features observed in the literature can be shown.…”

Section: Casementioning

confidence: 99%

“…The etiology of hypertrophic spinal pachymeningitis (HSP) is still unknown in most cases, although various associated diseases have been recognized, including trauma, metabolic disease, sarcoidosis, infections such as syphilis, tuberculosis, HTLV-1, meningococcal meningitis, granulomatous sinusitis, mastoid sinusitis and fungal infection 2,3,5,10,11,13,14) . Also, HSP has been associated with various autoimmune disease including Wegener's granulomatosis, rheumatoid arthritis, orbital pseudotumor, multifocal fibrosclerosis and mixed connective tissue disease 2,3,8) .…”

Section: Casementioning

confidence: 99%

“…Also, HSP has been associated with various autoimmune disease including Wegener's granulomatosis, rheumatoid arthritis, orbital pseudotumor, multifocal fibrosclerosis and mixed connective tissue disease 2,3,8) . Intrathecal steroids, spinal anesthesia, and contrast medium for myelography also have been implicated as a cause of HSP 10,11,14) .…”

Section: Casementioning

confidence: 99%

“…If decompressive surgery is necessary, laminoplasty have been recommended instead of extensive laminectomy because the former could reduce chronic back discomfort and would enhance spinal stability 3,11) . Others have emphasized postoperative radiotherapy, immunosuppressive therapy such as azathioprine, and cyclophosphamide 2,3,12,14) . Among our two patients, one recovered from the weakness, the other did not recover from the quadriplegia status.…”

Section: Casementioning

confidence: 99%

“…For IHSP, surgical decompression by laminectomy and excision or incision of the involved dura has been recommended 2,3,5,11,13,14) . Recently, some case reports witnessed that biopsy with steroid therapy can decrease the thickness of the dura by serial MRI and can improve neurologic deficit 3,9) .…”

Section: Casementioning

confidence: 99%

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Idiopathic Hypertrophic Spinal Pachymeningitis : Report of Two Cases and Review of the Literature

Kim

Park

Chin

2011

J Korean Neurosurg Soc

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392ed 7 months ago and worsened gradually. Her family and past histories were noncontributory. There was no trauma history. On physical examination, motor and sensory function were intact. Her deep tendon reflexes and ankle clonus were checked as normal. There was no documented fever or leukocytosis [White blood cell (WBC) count 6,280/uL]. However, erythrocyte sedimentation rate (ESR) was elevated to 47 mm/hr (normal : 0-20 mm/hr), and C-reactive protein (CRP) level also was elevated to 37.9 mg/L (normal : 0.1-6.0 mg/L). Other laboratory data were within normal ranges and various culture studies revealed no growth. Initial magnetic resonance imaging (MRI) showed an epidural lesion involving from C6 vertebral body level to mid-thoracic spine area with low signal intensity on T1 (Fig. 1A) and T2 (Fig. 1B) weighted images.The patient was treated initially with dexamethasone 5 mg every 6 hours for 7 days, but she had no improvement. Seven days later, follow-up MRI with gadolinium enhancement revealed diffuse homogeneous enhancement (Fig. 2) which was suspected as acute or early subacute stage of epidural hematoma, surgical exploration was done. Total laminectomies of T6 and T7, lesional biopsies were performed immediately. No extradural abnormality was visible during the operation. After INTRODUCTIONIdiopathic hypertrophic spinal pachymeningitis (IHSP) is a comparatively rare disorder characterized by marked inflammatory hypertrophy of the dura mater, with subsequent neurological deficits resulting from the compression of adjacent structures 3) . We present two cases of IHSP with description of etiologies, diagnoses, managements and clinical outcomes. CASE REPORT Case 1A 55-year-old woman visited to our hospital complaining of back pain, progressive paraparesis, both leg numbness, and voiding difficulty in July, 2009. These symptoms had been start- Idiopathic hypertrophic spinal pachymeningitis (IHSP) is a rare inflammatory disease characterized by hypertrophic inflammation of the dura mater and various clinical courses that are from myelopathy. Although many associated diseases have been suggested, the etiology of IHSP is not well understood. The ideal treatment is controversial. In the first case, a 55-year-old woman presented back pain, progressive paraparesis, both leg numbness, and voiding difficulty. Initial magnetic resonance imaging (MRI) demonstrated an anterior epidural mass lesion involving from C6 to mid-thoracic spine area with low signal intensity on T1 and T2 weighted images. We performed decompressive laminectomy and lesional biopsy. After operation, she was subsequently treated with steroid and could walk unaided. In the second case, a 45-year-old woman presented with fever and quadriplegia after a spine fusion operation due to lumbar spinal stenosis and degenerative herniated lumbar disc. Initial MRI showed anterior and posterior epidural mass lesion from foramen magnum to C4 level. She underwent decompressive laminectomy and durotomy followed by steroid therapy. However, her conditions deteriorate...

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