Headache, chest pain, and multiplex cranial neuropathy
- 10 Downloads
A 58-year-old man with unremarkable past medical history presented with severe episodic right-side periocular pain radiating to the frontal-temporal-parietal region, associated with unstable diplopia in the horizontal gaze. The clinical examination showed partial palsy of the right third cranial nerve sparing the intrinsic function. Prednisone 50 mg daily for 2 weeks was prescribed with sudden relief of pain and recovery of diplopia. Fifteen days after prednisone withdrawal, headache and diplopia caused by right sixth cranial nerve palsy reappeared. Intravenous methylprednisolone (1 g daily for 3 days) was given with transient full recovery. Two weeks later, the patient was readmitted due to recurrent severe headache and started prednisone 75 mg daily. Nevertheless, he developed diffuse chronic headache, bilateral sixth and partial left third cranial nerve palsy, right-side Claude-Bernand-Horner syndrome, dysphagia and dysphonia, intense chest pain, and gait unsteadiness...
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 5.Falk RJ, Gross WL, Guillevin L, Hoffman GS, Jayne DR, Jennette JC, Kallenberg CG, Luqmani R, Mahr AD, Matteson EL, Merkel PA, Specks U, Watts RA, American College of R, American Society of N, European League Against R (2011) Granulomatosis with polyangiitis (Wegener’s): an alternative name for Wegener’s granulomatosis. Arthritis Rheum 63(4):863–864. https://doi.org/10.1002/art.30286 CrossRefPubMedGoogle Scholar
- 7.Nagashima T, Maguchi S, Terayama Y, Horimoto M, Nemoto M, Nunomura M, Mori M, Seki T, Matsukawa S, Itoh T, Nagashima K (2000) P-ANCA-positive Wegener’s granulomatosis presenting with hypertrophic pachymeningitis and multiple cranial neuropathies: case report and review of literature. Neuropathology 20(1):23–30CrossRefGoogle Scholar
- 8.Nakano Y, Miyawaki Y, Sada KE, Yamamura Y, Kano Y, Hayashi K, Watanabe H, Matsumoto Y, Kawabata T, Wada J (2018) Development of hypertrophic pachymeningitis in a patient with antineutrophil cytoplasmic antibody-negative eosinophilic granulomatosis with polyangiitis. J Clin Rheumatol:1. https://doi.org/10.1097/RHU.0000000000000694
- 9.Peng A, Yang X, Wu W, Xiao Z, Xie D, Ge S (2018) Anti-neutrophil cytoplasmic antibody-associated hypertrophic cranial pachymeningitis and otitis media: a review of literature. Eur Arch Otorhinolaryngol 275:2915–2923. https://doi.org/10.1007/s00405-018-5172-4 CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Shobha N, Mahadevan A, Taly AB, Sinha S, Srikanth SG, Satish S, Nandagopal R, Arunodaya GR, Chandramouli BA, Shankar SK (2008) Hypertrophic cranial pachymeningitis in countries endemic for tuberculosis: diagnostic and therapeutic dilemmas. J Clin Neurosci 15(4):418–427. https://doi.org/10.1016/j.jocn.2007.03.003 CrossRefPubMedGoogle Scholar
- 12.Chen H, Zhang W, Jing J, Raza HK, Zhang Z, Zhu J, Liu Y, Cui G, Hua F, Dong L (2018) The clinical and imaging features of hypertrophic pachymeningitis: a clinical analysis on 22 patients. Neurol Sci. https://doi.org/10.1007/s10072-018-3619-4
- 13.Matsumoto K, Akiyama M, Kajio N, Otomo K, Suzuki K, Nishina N, Kasuya K, Oishi N, Kameyama K, Takeuchi T (2018) Adolescent PR3-ANCA-positive hypertrophic pachymeningitis: a case report and review of the literature. Medicine 97(17):e0521. https://doi.org/10.1097/MD.0000000000010521 CrossRefPubMedPubMedCentralGoogle Scholar