Hypertrophic Pachymeningitis. A Case Report.

We report a case of hypertrophic pachymeningitis in a 64 year-old female. On August, 1994, She developed headache and pyrexia and after two months, back and low back pain appeared. Pyogenic pachymeningitis was diagnosed by analysis of spinal fluid in an other hospital. Despite antibiotic treatment, paresis of bilateral lower extremities and dysuria appeared progressively. Manual muscle testing revealed grade 4-5 strength. Sensory disturbance occurred at S2-3 level. MRI showed compression on the left anterior side at Th11-L1. Laminectomy of Th11 to L1 was performed, but the patient's symptoms didn't improve. Sixteen days postoperatively, paralysis of bilateral lower extremities suddenly appeared. Repeat surgery with laminectomy of Th9 to L2 was performed. Markedly thickened dura compressing the cord was noted and this was partially excised. Hypertrophic dura was infiltrated by pathological lymphocytes and plasmacytes, and the pathological diagnosis was chronic hypertrophic pachymeningitis. After re-operation, steroids were administered and inflammation disappeared, however bilateral lower extremity paralysis didn't improve.This is a report of hypertrophic pachymeningitis which was difficult to diagnose and illustrates that steroids were effective in suppressing inflammation.