Abstract

Intracranial pachymeningitis (ICPM) is a chronic inflammatory thickening of the dura mater. They are relatively rare and may be secondary or idiopathic. We report an illustrative case with literature review. This is a 56-year-old diabetic insulin patient with a history of neglected head trauma with permanent subacute headaches and vertigo associated with fever and confusion. Upon examination, he had sequelae of right temporal sore with emission of pus, and monoparesis of the left upper limb. A cerebral CT scan made without and contrast material, found a right temporal bone defect, a right fronto-temporo-parietal bone thickening, a right frontal image in cockade and sub-factorial cerebral herniation. Surgical exploration found a cerebral abscess with thickening of bone and dura mater. Pathological examination concluded on chronic osteomyelitis and chronic inflammatory infiltration of the dura mater. The bacteriological examination found a flora made of negative coagulase Staphylococcus, Enterobacter cloacae, beta-hemolytic Streptococcus. This was treated with triple antibiotherapy (ceftriaxone, metronidazole, vancomycin) with a good evolution of brain abscess. The etiologies of pachymeningitis in literature are mainly inflammatory, carcinomas, tuberculosis and trauma. The treatment must be adapted on a case by case basis.

Keywords: Pachymeningitis; Cerebral Abscess; Chronic Osteitis; Head Trauma

References

1. N Ech-Cherif., et al. “Les pachyméningites intracrâniennes: aspects TDM et IRM”. Feuillets de Radiologie5 (2012): 298.
2. Richard L Drake., et al. “Gray’s anatomie pour les étudiants”. Elsevier Masson (2006): 818.
3. Frank H Netter. “Atlas d'anatomie humaine”. 5^th édition. Elsevier Saunders, USA: 101.
4. Olivier Fain and A Mekinian. “Les pachyméningites”. La Revue De Médecine Interne, Elsevier (2017).
5. Brüggemann N., et al. “Cranial pachymeningitis: a rare neurological syndrome with heterogeneous aetiology”. Journal of Neurology, Neurosurgery, and Psychiatry 3 (2010): 294-298.
6. Charcot JM and Joffroy A. “Deux cas d’atrophie musculaire progressive avec lésions de la substance grise et des faisceaux antérolatéraux de la moelle épinière”. Archives of Physiology and Normal Pathology 2 (1869): 354-367, 629-649, 744-769.
7. Naffziger HC and Stern WE. “Chronic pachymeningitis: report of a case and review of the literature”. Archives of Neurology and Psychiatry 4 (1949): 383-411.

Citation

Citation: Fah Bouaré. et al. “Pachymeningitis and Cerebral Abscess Complicating Chronic Osteomyelitis".Acta Scientific Neurology 3.4 (2020): 40-43.

Copyright

Copyright: © 2020 Fah Bouaré. et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.