Imaging features, clinicopathological analysis and diagnostic strategy of IgG4-related hypertrophic pachymeningitis

Zhao, Yi‐Lei; Xu, Jiming

doi:10.21037/apm-19-452

Cited by 9 publications

(10 citation statements)

References 17 publications

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“…MRI is an important diagnostic tool in TBM. 2 MRI in TBM which generally shows focal enhancement in basal pial areas, particularly in the interpeduncular fossa However, in our case MRI brain was normal.…”

Section: Discussioncontrasting

confidence: 66%

“…Tubercular infection in CNS results in the granulomatous inflammatory response in meninges, cistern and parenchyma. 2 …”

Section: Discussionmentioning

confidence: 99%

“…1 Diagnosis of TBM is usually based on clinical evidence combined with imaging, lab findings and CSF findings. 2 If left untreated, the case fatality rate is 100%. Patients usually present with non-specific symptoms like fatigue, malaise, anorexia, weight loss, fever and headache.…”

Section: Introductionmentioning

confidence: 99%

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Loss of Consciousness and Cardiac Arrest as an Atypical Presentation of Tubercular Meningitis: A Case Report

Yadav¹,

Acharya²,

Thapa³

et al. 2022

J Nepal Med Assoc

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Tubercular meningitis is a devastating presentation of extra pulmonary tuberculosis, with fatality in each case without treatment. A 39 years male, a regular consumer of alcohol and a known case of major depressive disorder, presented with the alleged history of using an electric heater in a closed room, and presented to emergency with unconsciousness and cardiac arrest. As his neurological status didn’t improve over 72 hrs, a magnetic resonance imaging brain was done which was non-conclusive. Electroencephalogram revealed diffuse right fronto-parietal seizure activity ceasing with midazolam injection, hence levetiracetam was started. Lumbar puncture revealed increased adenosine deaminase and nil white blood cells. Repeat lumbar puncture showed lymphocytic–predominant pleocytosis, elevated protein and low glucose. The patient was started on anti-tubercular therapy and an injection of dexamethasone was added. Repeat electroencephalogram didn’t show any seizure-like activity. It is important to be aware of variety of presentations of tubercular meningitis. Delay in treatment leads to irreversible neurological damage and even death.

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Section: Discussioncontrasting

confidence: 66%

“…Tubercular infection in CNS results in the granulomatous inflammatory response in meninges, cistern and parenchyma. 2 …”

Section: Discussionmentioning

confidence: 99%

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Loss of Consciousness and Cardiac Arrest as an Atypical Presentation of Tubercular Meningitis: A Case Report

Yadav¹,

Acharya²,

Thapa³

et al. 2022

J Nepal Med Assoc

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“…[6,12,13,32,38] Radiologically, IgG4-related mass lesions, as in our case, present as homogenously enhanced lesions, which are isointense to hypointense on T1-weighted and T2-weighted images. [6,12,13,32,38,40] ree histopathological findings characterize the disease in the affected organ: (1) e presence of a storiform pattern of sclerosis; (2) a dense lymphoplasmacytic infiltrate; and (3) an increased proportion of IgG4-positive cells with respect to IgG-positive cells according to immunohistochemical evidence. Although elevated concentrations of IgG4 in tissue and serum are helpful in diagnosing IgG4-RD, neither one is a specific diagnostic marker.…”

Section: Discussionmentioning

confidence: 99%

“…Radiologically, IgG4-related mass lesions, as in our case, present as homogenously enhanced lesions, which are isointense to hypointense on T1-weighted and T2-weighted images. [ 6 , 12 , 13 , 32 , 38 , 40 ]…”

Section: Discussionmentioning

confidence: 99%

Immunoglobulin G4-related disease of the cavernous sinus with orbit invasion – A case report

Mayeku

Deisch

López-González

2021

Surgical Neurology International

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Background: Immunoglobulin G4-related disease (IgG4-RD) is a rare systemic disease of unknown etiology. It is characterized by tissue infiltration caused by IgG4 plasma cells and sclerosing inflammation of various body organs. At present, there are very few reported cases of IgG4-RD invasion of cavernous sinus and the orbit. Case Description: A 56-year-old female with a history of rheumatoid arthritis was presented with a gradual onset of right oculomotor, abducens, and trigeminal nerve deficits. Four weeks after the onset of symptoms, the patient developed gradual visual deficit. Following this, a trial of steroids was administered to the patient. However, the treatment did not work as expected and patient’s condition worsened. She progressed on to suffer complete visual loss in the right eye. Extensive work-up conducted on her turned out to be nondiagnostic. After this, the patient was referred to us for our evaluation. Neuroimaging revealed a right-sided cavernous sinus and orbital apex lesion. Given the lack of diagnosis and response to steroid treatment, we recommended surgical intervention and performed a modified pterional and pretemporal approach with extradural anterior clinoidectomy and transcavernous approach. We performed a lesion biopsy and cavernous sinus decompression, which helped in the partial recovery of visual function. The pathology report was consistent with IgG4-RD. Conclusion: IgG4-RD is a rare disease that occurs even less in combination with cavernous sinus and orbit invasion. The rarity of the disease and the diverse presentation of symptoms have sometimes caused delayed diagnosis and intervention. Patients who failed to respond to conservative management and patients in the fibrotic stage of the disease without other organ involvement may benefit from surgical intervention if amenable. Early suspicion, diagnosis, and intervention can facilitate better prognosis.

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Les sous-classes d’IgG dans le LCR présentent-elles un réel intérêt ?

Martinroche

Charpy

Goret

2023

Revue Francophone des Laboratoires

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Imaging features, clinicopathological analysis and diagnostic strategy of IgG4-related hypertrophic pachymeningitis

Cited by 9 publications

References 17 publications

Loss of Consciousness and Cardiac Arrest as an Atypical Presentation of Tubercular Meningitis: A Case Report

Loss of Consciousness and Cardiac Arrest as an Atypical Presentation of Tubercular Meningitis: A Case Report

Immunoglobulin G4-related disease of the cavernous sinus with orbit invasion – A case report

Les sous-classes d’IgG dans le LCR présentent-elles un réel intérêt ?

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