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- CLINICA NEUROL, 44: 527－530, 2004
- Vol.44 No.8 contents
Case Report
A case of hypertrophic pachymeningitis, resolved by antimicrobial therapy
Yukako Sato, M.D., Masahiko Aoyama, M.D., Tomoko Soeda, M.D., Akihiko Hoshi, M.D., Mari Honma, M.D., and Teiji Yamamoto, M.D.
Department of Neurology, Fukushima Medical University
A 65-year-old woman with diabetes mellitus and chronic otitis media developed headache, fever, and hoarseness, all of which did not responded to the oral antibiotics. As stiff neck and lower cranial nerve palsies appeared, bacterial meningitis was suspected. Neurological examination revealed the right hearing disturbance, right recurrent laryngeal nerve palsy, left sternocleidomastoid muscle atrophy and bilateral tongue atrophy. The CSF examination revealed mild pleocytosis and elevated protein, but no bacterial organism was cultured from the CSF. CT scans showed bilateral mastoiditis, and the right mastoid process and a posterior part of the petrous bone were eroded, indicating the exposed bony structures to the posterior fossa. MRI scans demonstrated the thickening of the dura mater of the posterior fossa and the right cerebellar tentorium. This is a rare example of bacterial pachymeningitis of the posterior fossa, the clinical symptoms and MRI findings of which resolved solely by antimicrobial agents without corticosteroid.
(CLINICA NEUROL, 44: 527－530, 2004)
key words: hypertrophic pachymeningitis, chronic otitis media, mastoiditis
(Received: 14-Nov-03)
