Rheumatology International

, Volume 25, Issue 3, pp 230–233 | Cite as

A case of idiopathic hypertrophic cranial pachymeningitis manifested only by positive rheumatoid factor and abnormal findings of the anterior falx

  • Motoko Kanemoto
  • Yasuhiro OtaEmail author
  • Taro Karahashi
  • Norio Nozue
Case Report


In this report, we present a rare case of a 52-year-old man with a unique form of hypertrophic pachymeningitis involving the anterior part of the falx and who was positive for rheumatoid factor. The clinical symptom was only headache, without any cranial nerve palsies or ataxia. Diagnosis was made by gallium scintigraphy and magnet resonance imaging but was not confirmed by dural biopsy. Treatment with corticosteroid alone was extremely effective for him, while in most cases hypertrophic pachymeningitis recurs or progresses despite the treatment.


Gallium scintigraphy Hypertrophic pachymeningitis Magnet resonance imaging Rheumatoid factor 


  1. 1.
    Berger JR, Snodgrass S, Glaser J, Post MJD, Norengerg M, Benedetto P (1989) Multifocal fibrosclerosis with hypertrophic intracranial pachymeningitis. Neurology 39:1345–1349PubMedGoogle Scholar
  2. 2.
    Masson C, Hénin D, Hauw JJ, Rey A, Raverdy P, Masson M (1993) Cranial pachymeningitis of unknown origin: a study of seven cases. Neurology 43:1329–1334PubMedGoogle Scholar
  3. 3.
    Hassin GB, Zeitlin H (1940) Syphilitic cerebral hypertrophic pachymeningitis. Arch Neurol 43:362–371Google Scholar
  4. 4.
    Michel D, Girard PF, Tommasi M, Masson R, Trillet M, Piccinali JP (1969) Intracranial granulomatous pachymeningitis with pseudotumoral symptomatology. Apropos of four cases. [French.] J Med Lyon 50:545–577Google Scholar
  5. 5.
    Feringa ER, Weathebee L (1975) Hypertrophic granulomatous cranial pachymeningitis causing progressive blindness in a chronic dialysis patient. J Neurol Neurosurg Psychiatry 38:1170–1176PubMedGoogle Scholar
  6. 6.
    Mamelak AN, Kelly WM, Davis RL, Rosenblum ML (1993) Idiopathic hypertrophic cranial pachymeningitis: report of three cases. J Neurosurg 79:270–276PubMedGoogle Scholar
  7. 7.
    Botella C, Orozco M, Navarro J, Riesgo P (1994) Idiopathic chronic hypertrophic craniocervical pachymeningitis: case report. Neurosurgery 35:1144–1149PubMedGoogle Scholar
  8. 8.
    Yur WTC, Drew JM, Rizzo M, Ryals TJ, Sato Y, Bell WE (1990) Evaluation of pachymeningitis by contrast enhanced MR imaging in a patient with rheumatoid disease. AJNR Am J Neuroradiol 11:1247–1248Google Scholar
  9. 9.
    Martin N, Masson C, Henin D (1989) Hypertrophic cranial pachymeningitis: assessment with CT and MR imaging. AJNR Am J Neuroradiol 10:477–484Google Scholar
  10. 10.
    Sugiyama Y, Shimizu M, Hoshi A, Aoki T, Matsuura Y, Tochikubo S et al (1999) An old man presenting with fluctuating bilateral multiple cranial nerve palsies and positive test for perinuclear antineutrophil cytoplasmic antibody [Japanese]. Brain and Nerve (Tokyo) 51:825–832Google Scholar
  11. 11.
    Higgins WL, Marano GD (1986) Gallium imaging of rheumatoid pachymeningitis. Clin Nucl Med 11:350–351PubMedGoogle Scholar
  12. 12.
    Otsuka M, Kuwata Y, Fujiwara T, Yamada S, Ueki A (1997) A case of rheumatoid hypertrophic pachymeningitis. Clin Neurol (Tokyo) 37:834–840Google Scholar
  13. 13.
    Li JY, Lai PH, Lam HC et al (1999) Hypertrophic cranial pachymeningitis and lymphocytic hypophysitis in Sjögren’s syndrome. Neurology 52:420–423PubMedGoogle Scholar
  14. 14.
    Manabe Y, Narai H, Warita H, Hayashi T, Sakai K, Abe K (2001) Rheumatoid factor positive hypertrophic cranial pachymeningitis in association with hypopituitarism and multiple cranial nerve palsies. Internal Medicine 40:964–967PubMedGoogle Scholar
  15. 15.
    Bathon JM, Moreiand LW, Di Bartolomeo AG (1989) Inflammatory central nervous system involvement in rheumatoid arthritis. Semin Arthritis Rheum 18:258–266CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Motoko Kanemoto
    • 1
  • Yasuhiro Ota
    • 2
    Email author
  • Taro Karahashi
    • 1
  • Norio Nozue
    • 1
  1. 1.Department of Internal Medicine, Section of RheumatologyFujieda Municipal General HospitalShizuokaJapan
  2. 2.Third Department of Internal MedicineHamamatsu University School of MedicineShizuoka 431-3192Japan

Personalised recommendations