Granulomatous meningitis.

We report idiopathic hypertrophic pachymeningitis in a previously-healthy 34-year-old Filipino man, who presented with third and sixth cranial nerve palsies, headache, vomiting and left proptosis. Magnetic resonance imaging of the brain showed diffuse dural thickening and enhancement, with mild cerebrospinal fluid lymphocytosis and slight protein elevation. The patient was treated with anti-tuberculous medications and steroids, and made good recovery. We discuss the differential diagnoses and various diagnostic tests with respect to granulomatous inflammation of the meninges.