Idiopathic hypertrophic pachymeningitis: An unusual masquerader of multiple cranial nerve palsies

Abstract

Idiopathic hypertrophic pachymeningtis is a rare inflammatory disorder affecting the dura mater. A 39-year-old diabetic male presented with left sixth nerve paresis along with ophthalmic and hypoglossal nerve involvement. Neuroimaging is an important tool for the neuroophthalmologist in such cases where it can point to a diagnosis as well as exclude common conditions like ischemic neuropathy in the absence of more invasive diagnostic tests. Magnetic resonance imaging (MRI) in our case revealed features suggestive of hypertrophic pachymeningitis. Secondary causes were ruled out with extensive investigations and the patient improved completely with systemic corticosteroids.

Keywords

• Corticosteroids
• hypertrophic pachymeningitis
• magnetic resonance imaging
• multiple cranial neuropathy