Teramoto Hiroko, Hara Makoto, Morita Akihiko, Kamei Satoshi
Division of Neurology, Department of Medicine, Nihon University School of Medicine.
Rinsho Shinkeigaku. 2015;55(1):33-6. doi: 10.5692/clinicalneurol.55.33.
A previously healthy 63-year-old man presented with a 2-weeks history of diplopia without headache. Neurological examination revealed total external ophthalmoplegia of the left eye and limitation of abduction of the right eye. Initial cranial MRI showed thickening and enhancement of the dura mater only on the anterior cranial fossa but unremarkable on the cavernous sinus. Idiopathic hypertrophic cranial pachymeningitis was diagnosed in the absence of demonstrable underlying infective, neoplastic, or systemic autoimmune disease by his clinical findings, laboratory tests and radiological examinations. Corticosteroid therapy was initiated with methylprednisolone (1,000 mg/day for 3 days), followed by oral prednisolone and tapering off. Eye movements improved with treatment and completely recovered within 4 weeks after starting administration, and cranial MRI at the 15 days after starting treatment showed improvement. We suggest that his ophthalmoplegia was caused by the inflammation of dura on the cavernous sinus beyond the thickening lesion of cranial MRI. In a case of bilateral ophthalmoplegia with or without headache, it is required to examine the dural thickening and enhancement on the anterior cranial fossa by cranial MRI.
一名63岁既往健康的男性，出现复视2周，无头痛症状。神经系统检查发现左眼完全性眼外肌麻痹，右眼外展受限。最初的头颅磁共振成像（MRI）显示仅在前颅窝硬脑膜增厚并强化，海绵窦未见明显异常。根据其临床表现、实验室检查及影像学检查，在未发现明显潜在感染、肿瘤或系统性自身免疫性疾病的情况下，诊断为特发性肥厚性硬脑膜炎。开始使用甲泼尼龙进行皮质类固醇治疗（1000mg/天，共3天），随后口服泼尼松龙并逐渐减量。治疗后眼球运动改善，开始用药后4周内完全恢复，开始治疗15天后的头颅MRI显示病情有所改善。我们认为，他的眼肌麻痹是由海绵窦硬脑膜炎症引起的，该炎症位于头颅MRI增厚病变范围之外。对于伴有或不伴有头痛的双侧眼肌麻痹病例，需要通过头颅MRI检查前颅窝硬脑膜增厚及强化情况。
