From the Research
Pachymeningitis is an inflammation of the dura mater, which is the outermost and toughest layer of the meninges that surrounds and protects the brain and spinal cord, and it can be classified as either cranial or spinal, with various causes including infections, autoimmune disorders, malignancies, or as a side effect of certain medications. This condition can develop from different causes, including infections (bacterial, fungal, or viral), autoimmune disorders, malignancies, or as a side effect of certain medications 1, 2, 3, 4. Common symptoms include persistent headaches, vision problems, hearing loss, cranial nerve palsies, and in severe cases, seizures or altered mental status.
Causes and Classification
Pachymeningitis can be caused by various factors, including:
- Infections (bacterial, fungal, or viral)
- Autoimmune disorders (such as IgG4-related disease or systemic lupus erythematosus)
- Malignancies
- Side effects of certain medications It can be classified as either cranial (affecting the brain) or spinal (affecting the spinal cord) 2, 3.
Diagnosis and Treatment
Diagnosis typically involves imaging studies like MRI, cerebrospinal fluid analysis, and sometimes biopsy of the dura mater 2, 3. Treatment depends on the underlying cause - infectious cases require appropriate antimicrobial therapy, while autoimmune-related pachymeningitis often responds to corticosteroids or immunosuppressive medications 1, 3, 4. The use of corticosteroids is a mainstay of treatment, and other immunosuppressive agents and steroid-sparing agents may have utility in the treatment of cases refractory to corticosteroids alone 3.
Clinical Manifestations and Prognosis
Clinical manifestations of pachymeningitis depend upon the location of the inflammatory lesions and compression of the adjacent nervous system structures 3. Headache and loss of cranial nerve function were the most common presenting features of hypertrophic cranial pachymeningitis 3. Early diagnosis and treatment are essential to prevent permanent neurological damage 1, 2, 3, 4.