Department of Neurology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
Ann Pharmacother. 2010 Apr;44(4):755-9. doi: 10.1345/aph.1M455. Epub 2010 Mar 2.
To report a case of hypertrophic cranial pachymeningitis (HCP) associated with the long-term administration of nonsteroidal antiinflammatory drugs (NSAIDs).
A 23-year-old man presented with recurrent headaches as the primary clinical manifestation. After the administration of the NSAIDs indomethacin and aceclofenac for 2 years, he developed signs of progressive cranial polyneuropathies (eg, II, III, V, VI, and VII palsy) and damage to the brainstem. Cranial contrast-enhanced magnetic resonance imaging (MRI) revealed curvilinear subdural enhancement and significant tentorium cerebelli and falx cerebri enhancements. Since antituberculosis treatment combined with corticosteroid therapy and analgesia with celecoxib for 40 days had not achieved satisfactory results, NSAIDs were discontinued and a single oral dose of a corticosteroid was given. No headaches were reported at a 6-month follow-up appointment. In addition, his cranial polyneuropathy improved significantly. Reexamination by contrast-enhanced MRI scan demonstrated that tentorial enhancement and thickening of the falx cerebri were markedly alleviated.
No additional causes of HCP were found during systematic investigation in this patient. In addition to headache, cranial polyneuropathy and thickened cerebral dura mater appeared after administration of NSAIDs for 2 years. The symptoms that appeared during the NSAID therapy were remarkably alleviated 5 months after medication discontinuation. Adverse drug reaction (ADR) assessment revealed that long-term administration of NSAIDs may be associated with the occurrence and development of HCP.
Long-term administration of NSAIDs is a probable cause of HCP. Clinicians should be aware of this ADR and avoid prescribing NSAIDs for an extended period.
报告 1 例与长期使用非甾体抗炎药（NSAIDs）相关的肥厚性硬脑膜炎（HCP）病例。
1 例 23 岁男性，以复发性头痛为主要临床表现。在使用 NSAIDs 吲哚美辛和双氯芬酸治疗 2 年后，他出现进行性颅神经病（如 II、III、V、VI 和 VII 麻痹）和脑干损伤的迹象。颅脑对比增强磁共振成像（MRI）显示曲线形硬膜下增强以及明显的小脑幕和大脑镰增强。由于抗结核治疗联合皮质类固醇治疗和塞来昔布镇痛 40 天未能取得满意效果，停用 NSAIDs，并给予单剂量皮质类固醇。6 个月随访时无头痛。此外，他的颅神经病明显改善。对比增强 MRI 扫描复查显示，小脑幕增强和大脑镰增厚明显缓解。
在对该患者进行系统检查时未发现 HCP 的其他病因。除头痛外，在使用 NSAIDs 2 年后出现颅神经病和增厚的硬脑膜。停用药物后 5 个月，出现的症状明显缓解。药物不良反应（ADR）评估显示，长期使用 NSAIDs 可能与 HCP 的发生和发展有关。
长期使用 NSAIDs 是 HCP 的一个可能原因。临床医生应意识到这种 ADR，避免长期开具 NSAIDs 处方。
