Iwasaki Shinichi, Ito Ken, Sugasawa Masashi
Department of Otolaryngology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
Otol Neurotol. 2006 Oct;27(7):928-33. doi: 10.1097/01.mao.0000231498.61781.ec.
To describe a series of patients with hypertrophic cranial pachymeningitis (HCP) associated with chronic middle ear inflammation.
Retrospective case review.
University Hospital.
Six consecutive patients between the years 2000 and 2004 who had both middle ear disease and HCP (three men and three women; age range, 36-72 yr, mean age, 58.2 yr). The diagnosis of HCP was made by the use of contrast-enhanced magnetic resonance imaging scans of the brain in all patients.
Contrast-enhanced magnetic resonance imaging (MRI) of the brain, dural biopsy, and otomicroscopic examination.
Thickening and abnormal enhancement of the dura mater on the MRI of the brain.
All of the six patients had chronic inflammatory middle ear diseases. Three patients had otitis media with effusion, two had chronic otitis media, and one had postoperative otorrhea. The most common presentations of HCP were headache and cranial nerve palsies. Cranial Nerves V and VIII were the most frequently involved. On contrast-enhanced MRI examination of the brain, an enhancement of the dura mater was observed on the same side as the middle ear diseases in five of the six patients, whereas bilateral enhancement was observed in one patient. Corticosteroid therapy was effective for alleviating the symptoms in all six patients.
Chronic middle ear inflammation might be involved in the pathogenesis of HCP, probably mediated by the venous return.
描述一系列与慢性中耳炎症相关的肥厚性硬脑膜炎（HCP）患者。
回顾性病例分析。
大学医院。
2000年至2004年间连续6例患有中耳疾病和HCP的患者（3名男性和3名女性；年龄范围36 - 72岁，平均年龄58.2岁）。所有患者均通过脑部增强磁共振成像扫描确诊为HCP。
脑部增强磁共振成像（MRI）、硬脑膜活检和耳显微镜检查。
脑部MRI上硬脑膜增厚及异常强化。
6例患者均患有慢性炎症性中耳疾病。3例患者有中耳积液，2例有慢性中耳炎，1例有术后耳漏。HCP最常见的表现是头痛和颅神经麻痹。第V和第VIII颅神经受累最为频繁。在脑部增强MRI检查中，6例患者中有5例在中耳疾病同侧观察到硬脑膜强化，1例观察到双侧强化。皮质类固醇治疗对所有6例患者的症状缓解均有效。
慢性中耳炎症可能参与了HCP的发病机制，可能是通过静脉回流介导的。
