A 26-year-old male presented with a 6-day history of paroxysmal headache which was worsen with nausea and vomiting for 1 day. Head CT on admission revealed left chronic subdural hematoma with midline shift. An emergency Burr hole drainage for hematoma was performed. Headache recurred 6 days later. MRI of the brain revealed a diffuse thickening and a gadolinium-enhancement of the falx, cranial dura mater and tentorium cerebelli on the left side with pia mater involved. Lumber puncture showed increased intracranial pressure and elevated IgG level in cerebrospinal fluid. Histological examination of the biopsy specimen showed thickened, fibrotic dura with a sterile chronic inflammation. According to pathological examination, idiopathic hypertrophic cranial pachymeningitis was considered as the final diagnosis. Symptoms were improved with steroid pulse therapy.
一例26岁男性患者，因“阵发性头痛6 d，加重伴恶心呕吐1 d”入院。头颅CT检查提示左侧额颞顶枕部慢性硬脑膜下血肿伴中线移位，急诊行左颞顶钻孔引流术。术后6 d头痛复发。头颅MRI提示左侧额颞顶枕部硬脑膜、大脑镰、左侧小脑幕广泛增厚伴强化，全脑软脑膜强化。腰椎蛛网膜下腔穿刺检查结果提示颅内压增高，脑脊液IgG水平升高。脑膜活检病理学检查提示脑膜纤维组织增生伴大量炎性细胞浸润。诊断特发性肥厚性硬脑膜炎，给予皮质激素冲击治疗后恢复良好。