Neurological Sciences

, Volume 32, Issue 3, pp 455–459 | Cite as

A case of subarachnoid hemorrhage with pituitary apoplexy caused by idiopathic hypertrophic pachymeningitis

  • Shoko M. Yamada
  • Makoto Aoki
  • Makoto Nakane
  • Hitoshi Nakayama
Case Report
First Online:
Received:
Accepted:

Abstract

Steroid therapy is considered to improve clinical symptoms in hypertrophic pachymeningitis. We present a 70-year-old man with idiopathic hypertrophic pachymeningitis, whose clinical signs progressively worsened despite steroid therapy. He died of subarachnoid hemorrhage (SAH) with pituitary apoplexy 2 months after the admission regardless of improvement of laboratory data and magnetic resonance imaging appearance by one-and-half-month steroid therapy. Autopsy revealed thickened dura mater supporting the diagnosis of hypertrophic pachymeningitis. Brain parenchyma is generally not affected by the disease; however, histological investigation suggested that inflammation of the dura caused damage to superior hypophyseal artery resulting in SAH and apoplexy in the anterior lobe of the pituitary gland. The higher dose and the longer duration of steroid therapy should have achieved in our case although most laboratory data recovered within the normal range. The aggressiveness of hypertrophic pachymeningitis must be evaluated by clinical signs rather than by laboratory data or imaging examinations.

Keywords

Hypertrophic pachymeningitis Pituitary apoplexy Steroid Skull base Hypopituitarism Neuropathy 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgments

We appreciate Dr. Yasuo Ishida, professor of department of pathology in Teikyo University Chiba Medical Center, for arranging histological pictures and giving comments for our case.

References

  1. 1.
    Murai H, Kira J, Kobayashi T, Goto I, Inoue H, Hasuo K (1992) Hypertrophic cranial pachymeningitis due to Aspergillus flavus. Clin Neurol Neurosurg 94(3):247–250PubMedCrossRefGoogle Scholar
  2. 2.
    Adachi M, Hayashi A, Ohkoshi N et al (1995) Hypertrophic cranial pachymeningitis with spinal epidural granulomatous lesion. Intern Med 34(8):806–810PubMedCrossRefGoogle Scholar
  3. 3.
    Kupersmith MJ, Martin V, Heller G, Shah A, Mitnick HJ (2004) Idiopathic hypertrophic pachymeningitis. Neurology 62(5):686–694PubMedGoogle Scholar
  4. 4.
    Rudnik A, Larysz D, Gamrot J et al (2007) Idiopathic hypertrophic pachymeningitis—case report and literature review. Folia Neuropathol 45(1):36–42PubMedGoogle Scholar
  5. 5.
    Masson C, Hénin D, Hauw JJ et al (1993) Cranial pachymeningitis of unknown origin: a study of seven cases. Neurology 43:1329–1334PubMedGoogle Scholar
  6. 6.
    Tanaka M, Suda M, Ishikawa Y, Fujitake J, Fujii H, Tatsuoka Y (1996) Idiopathic hypertrophic cranial pachymeningitis associated with hydrocephalus and myocarditis: remarkable steriod-induced remission of hypertrophic dura mater. Neurology 46(2):554–556PubMedGoogle Scholar
  7. 7.
    Hatano N, Behari S, Nagatani T et al (1999) Idiopathic hypertrophic cranial pachymeningitis. Clinicoradiological spectrum and therapeutic options. Neurosurgery 45:1336–1344PubMedCrossRefGoogle Scholar
  8. 8.
    Sylaja PN, Cherian PJ, Das CK, Radhakrishnan VV, Radhakrishnan K (2002) Idiopathic hypertrophic cranial pachymeningitis. Neuro India 50(1):53–59Google Scholar
  9. 9.
    Mikawa Y, Watanabe R, Hino Y, Hirano K (1994) Hypertrophic spinal pachymeningitis. Spine 19:620–625PubMedCrossRefGoogle Scholar
  10. 10.
    Olmos PR, Falko JM, Rea GL, Boesel CP, Chakeres DW, McGhee DB (1999) Fibrosing pseudotumor of the sella and parasellar area producing hypopituitarism and multiple cranial nerve palsies. Neurosurgery 32:1015–1021CrossRefGoogle Scholar
  11. 11.
    Kitai R, Sato K, Kutoba T, Kabuto M, Uno H, Kobayashi H (1997) Hypertrophic cranial pachymeningitis involving the pituitary grand: a case report. Surg Neurol 48:58–63PubMedCrossRefGoogle Scholar
  12. 12.
    Manabe Y, Narai H, Warita H, Hayashi T, Sakai K, Abe K (2001) Reumatoid factor positive hypertrophic cranial pachymeningitis in association with hypopituitarism and multiple cranial nerve palsies. Intern Med 40:964–967PubMedCrossRefGoogle Scholar
  13. 13.
    Skierczynski PA, Goodman JM, Signal P, Payner TD, Bonnin JM (2007) Idiopathic hypertrophic pachymeningitis resulting in delayed panhypopituitarism. Endocr Pract 13(5):481–486PubMedGoogle Scholar
  14. 14.
    Hamilton SR, Smith CH, Lessell S (1993) Idiopathic hypertrophic cranial pachymeningitis. J Clin Neuroophthalmol 13(2):127–134PubMedGoogle Scholar
  15. 15.
    Ruiz-Sandoval JL, Bernard-Medina G, Ramos-Gómez EJ et al (2006) Idiopathic hypertrophic cranial pachymeningitis successfully treated with weekly subcutaneous methotrexate. Acta Neurochir (Wien) 148(9):1011–1014 (epub 18 April 2006)CrossRefGoogle Scholar
  16. 16.
    Bosman T, Simonin C, Launay D, Caron S, Destée A, Defebvre L (2008) Idiopathic hypertrophic cranial pachymeningitis treated by oral methotrexate: a case report and review of literature. Rheumatol Int 28:713–718PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Shoko M. Yamada
    • 1
    • 2
  • Makoto Aoki
    • 1
  • Makoto Nakane
    • 1
  • Hitoshi Nakayama
    • 1
  1. 1.Department of NeurosurgeryTeikyo University Mizonokuchi HospitalKawasakiJapan
  2. 2.Department of NeurosurgeryTeikyo University Chiba Medical CenterIchiharaJapan

Personalised recommendations