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KMID : 1150320220180010021
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Journal of Korean Society of Geriatric Neurosurgery
2022 Volume.18 No. 1 p.21 ~ p.25
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Idiopathic hypertrophic spinal pachymeningitis with compressive myelopathy: a case report
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Shin Tae-Hwan
Kim Tae-Woo
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Abstract
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Idiopathic hypertrophic spinal pachymeningitis (IHSP) is a rare condition characterized by chronic progressive diffuse inflammatory fibrosis in the dura mater of the spinal cord. Depending on its extent or severity, IHSP may cause symptoms by compressing the spinal cord. We present a case of IHSP across the cervical dura mater in a 78-year-old male patient. The patient visited the emergency department for right shoulder pain a month before admission, weakness in the right upper extremity a week before admission, and sudden quadriparesis on the day of admission. A neurological examination of the motor power of the extremities indicated grade IV quadriparesis and grade I hand grasp power in both hands. Hypoesthesia under the T1 dermatome was evaluated. Cervical magnetic resonance imaging (MRI) with gadolinium enhancement showed diffuse thickening of the anterior and posterior dura through the C2 to C5 levels, causing central canal stenosis and compressive myelopathy. Immediate decompressive laminoplasty was performed. A biopsy specimen of the thickened dura mater was obtained during surgery, and IHSP was diagnosed on the basis of the results of the pathological examination. High-dose steroid therapy was administered after decompressive surgery, and follow-up MRI showed radiological improvement in the lesion area.
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KEYWORD
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Dural thickening, Idiopathic hyperthrophic pachymeningitis, Myelopathy
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