Idiopathic Hyperplastic Pachymeningitis: Case Report

Activity: Talk or presentation types › Poster presentation

Description

Idiopathic hyperplastic pachymeningitis (IHP) is a disease affecting the dura mater. Pachymeningitis usually causes progressive cranial nerve neuropathies, chronic headaches, and cerebellar dysfunction, which significantly reduces quality of life. Aim of the study is to demonstrate a clinical case of a rare neurological disease.. A single patient with IHP is reviewed in a retrospective study.. Patient was hospitalized with complaints about chronic headaches, photophobia, phonophobia, dizziness and balance disorder. Chronic granulomatous uveitis, iridocyclitis associated with positive HLA B27 with secondary glaucoma in both eyes since 2019 is known from anamnesis. In July, 2020 patient had an aseptic meningitis, left-sided pneumonia. Patient consulted by ophtalmologist and got therapy for iridocyclitis. Etiology of the meningitis wasn’t detected. First time patient examined by neurologist in summer of 2021, while she was hospitalized due to chronic headaches. There was a pleocytosis (160/mkl) in a cerebrospinal fluid and clinical picture of serous meningitis. Head MRI, CT of the chest and abdomen, cerebrospinal fluid multiple analyses were done, but etiological cause has not been identified. Pacient's condition became worse in October 2021, she had an visual and hearing impairments, so patient was re-hospitalized in Neurology ward. Repeated lumbal puncture shown negative dynamics – pleocytosis increased (311/mkl). After repeated examination, pacient was offered to do the meningeal biopsy to clarify the etiological factor of chronic meningitis. As the result chronic hyperplastic meningitis morfology is presented, and inflammation of an autoimmune etiology cannot be ruled out. Patient received a course of Rituximab therapy (1000mg twice). In October, 2022 patient had a MRI for IHP control in dynamics – any new intracranial changes not detected. In the background of the Rituximab therapy, progression of the disease has stopped. . This clinical case shows that in patients with chronic pachymeningitis of undetected etiology a meningeal biopsy should be done.
Period29 Mar 2023
Event titleRSU International Research Conference 2023: Knowledge for Use in Practice
Event typeConference
OrganiserRīga Stradiņš University
LocationRiga, LatviaShow on map
Degree of RecognitionInternational

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