Pachymeningitis, Painful Ophthalmoplegia, and Multiple Cranial Neuropathy of Presumed Tuberculous Origin

Abstract

The authors describe a patient with persistent headache initially diagnosed as idiopathic hypertrophic pachymeningitis after a comprehensive study that included meningeal biopsy. Despite early response to corticosteroids, the headache relapsed 3 years later and he further developed painful ophthalmoplegia and multiple cranial neuropathies (V1, VI, VIII, and X). A cervical lymph node biopsy revealed caseating granulomas and antituberculous therapy was started. Symptoms had resolved at 3-month follow-up. The authors discuss tuberculosis as a possible cause of pachymeningitis, painful ophthalmoplegia, and multiple cranial neuropathy syndromes, and describe the common features of these clinical conditions.

Keywords::

• pachymeningitis
• painful ophthalmoplegia
• Tolosa-Hunt syndrome
• tuberculosis

ACKNOWLEDGEMENTS

We are grateful to Carolyn Newey for reviewing the English.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.