Zhang Xin
Department of Ophthalmology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China.
Medicine (Baltimore). 2024 Dec 6;103(49):e40903. doi: 10.1097/MD.0000000000040903.
Hypertrophic pachymeningitis (HP) is a rare and complex condition marked by inflammation and thickening of the dura mater. It can occur either on its own or as a result of various underlying medical issues. This type of granulomatous meningitis is extremely rare and poorly understood, making diagnosis and treatment particularly challenging. Patients with HP may experience severe headaches and cranial nerve defects, but in some cases, the condition can occur without any symptoms, making it undetected. We detail the case of patient who was diagnosed with HP after presenting with abducens nerve palsy, a condition that significantly affected her vision and quality of life. Remarkably, she showed substantial recovery following a course of methylprednisolone pulse therapy, coupled with careful radiographic diagnosis and follow-up assessments. The decision to report this case stems from its rarity and the diverse clinical manifestations associated with this condition, which can vary widely among patients.
A 26-year-old Asian female, sought medical attention at The First Affiliated Hospital of Zhejiang Chinese Medical University, where she reported experiencing diplopia, a troubling symptom indicative of abducens nerve palsy.
To establish a definitive diagnosis, second-generation sequencing biological detection was employed to rule out any infectious causes, while radiographic imaging provided confirmation of HP.
In terms of intervention, the patient was promptly initiated on a regimen of methylprednisolone pulse therapy, followed by a carefully monitored oral sequential reduction of the medication. Throughout her treatment, she underwent regular liver function tests to ensure her safety, and liver protective drugs were also administered as a precautionary measure.
As of now, the patient has successfully completed her treatment and is reported to be doing well, marking a positive outcome in her recovery journey.
This case underscores the critical importance of imaging examinations in the clinical diagnosis of patients presenting with diplopia, as they play a vital role in both diagnosing and differentiating between various diseases. Furthermore, it is essential to rule out any infection-related factors in patients diagnosed with HP before commencing treatment with glucocorticoids, ensuring a comprehensive approach to patient care.
肥厚性硬脑膜炎（HP）是一种罕见且复杂的病症，其特征为硬脑膜的炎症和增厚。它可单独发生，也可由各种潜在的医学问题引发。这种类型的肉芽肿性脑膜炎极为罕见，人们对其了解甚少，这使得诊断和治疗极具挑战性。HP患者可能会出现严重头痛和颅神经缺损，但在某些情况下，该病症可能毫无症状，从而未被察觉。我们详细介绍了一名患者的病例，该患者在出现外展神经麻痹后被诊断为HP，此病症严重影响了她的视力和生活质量。值得注意的是，在接受了甲泼尼龙脉冲治疗疗程，并辅以仔细的影像学诊断和随访评估后，她有了显著的康复。报告此病例的决定源于其罕见性以及与该病症相关的多样临床表现，这些表现因患者而异。
一名26岁的亚洲女性到浙江中医药大学附属第一医院就诊，她报告自己出现复视，这是一种令人困扰的症状，提示外展神经麻痹。
为了做出明确诊断，采用了二代测序生物检测以排除任何感染性病因，同时影像学检查确诊为HP。
在干预方面，患者迅速开始接受甲泼尼龙脉冲治疗方案，随后仔细监测口服药物逐步减量。在整个治疗过程中，她定期进行肝功能检查以确保安全，还预防性地使用了肝脏保护药物。
截至目前，患者已成功完成治疗，据报告情况良好，这标志着她康复过程取得了积极成果。
该病例强调了影像学检查在出现复视患者临床诊断中的至关重要性，因为它们在诊断和区分各种疾病方面都起着关键作用。此外，在对诊断为HP的患者开始使用糖皮质激素治疗之前，排除任何与感染相关的因素至关重要，这确保了对患者的全面护理。
