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• Vol.51 No.4
• CLINICA NEUROL, 51: 267−270, 2011
• Vol.51 No.4 contents

Case Report

Tuberculous cranial pachymeningitis presenting with long-standing diffuse brain dysfunction

Toshihisa Sugita, M.D., Hirotaka Katoh, M.D., Daigo Hayashi, M.D., Yohei Ohnaka, M.D., Masashi Nakajima, M.D. and Mitsuru Kawamura, M.D.

Department of Neurology, Showa University School of Medicine

We report a 59-year-old immunocompetent man presenting with slowly progressive gait unsteadiness, dysarthria, and clumsiness in writing over 6 months. There were bilateral pyramidal signs, pseudobulbar palsy, and attention deficits. Cerebrospinal fluid examination showed mild mononuclear pleocytosis, and magnetic resonance imaging revealed pachymeningeal pattern of contrast enhancement beneath the calvarium and the posterior cranial fossa. Interferon-gamma release assay in whole blood after stimulation by specific tuberculosis antigens was positive and repeat polymerase chain reaction assay detected Mycobacterium tuberculosis genome in the cerebrospinal fluid. After combination therapy with anti-tuberculous agents and corticosteroids, the patient's pachymeningitis regressed. Tuberculous cranial pachymeningitis may present with chronic diffuse brain dysfunction without headache, fever, or cranial nerve dysfunction.
Full Text of this Article in Japanese PDF (451K)

(CLINICA NEUROL, 51: 267−270, 2011)
key words: tuberculous cranial pachymeningitis, hypertrophic pachymeningitis, interferon-gamma release assay

(Received: 4-Dec-10)