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Idiopathic hypertrophic spinal pachymeningitis: a case report and review of literature

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Abstract

Purpose

To report an unusual case of idiopathic hypertrophic spinal pachymeningitis (IHSP) with a review of relevant literature and to discuss the etiology, clinical features, imaging, treatment and prognosis of IHSP.

Methods

The case of a 44-year-old woman is reported. MEDLINE was used to search relevant literatures written in English since 2004.

Results

The patient suffered from progressive mild thoracic backache followed by truncal and lower extremity weakness, numbness and urinary retention. The diagnosis was confirmed by magnetic resonance (MR) imaging and histopathologic examination. Although she received corticosteroid therapy and decompressive surgery, the patient suffered a rapid relapse probably because of the withdrawal of postoperative steroid therapy.

Conclusions

IHSP is a rare disease characterized by inflammatory hypertrophy of the dura mater without identifiable cause and featured clinical progress of radiculalgia to myelopathy. It is a diagnosis of exclusion. In our view, surgical decompression with postoperative steroid therapy may be optimal. Furthermore,we speculated that increased levels of protein and cell count in cerebrospinal fluid (CSF) might be positively related to the disease progression. High inflammatory signs or CSF protein and cell levels before surgery or postoperative residual lesions are possible reasons of poor prognosis in patients with IHSP.

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Conflict of interest

The authors have no actual or potential conflicts of interest to report.

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Authors and Affiliations

  1. Department of Neurology, The Second Xiangya Hospital, Central South University, 139 # the People Road, Changsha, 410011, P.R. China

    Li-xia Qin, Chun-yu Wang, Zhi-ping Hu, Liu-wang Zeng, Li-ming Tan & Hai-nan Zhang

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  1. Li-xia Qin
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  2. Chun-yu Wang
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  3. Zhi-ping Hu
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  4. Liu-wang Zeng
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  5. Li-ming Tan
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Correspondence to Hai-nan Zhang.

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Qin, Lx., Wang, Cy., Hu, Zp. et al. Idiopathic hypertrophic spinal pachymeningitis: a case report and review of literature. Eur Spine J 24 (Suppl 4), 636–643 (2015). https://doi.org/10.1007/s00586-015-3958-2

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  • DOI: https://doi.org/10.1007/s00586-015-3958-2

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