Hypertrophic pachymeningitis is a rare disorder that causes intracranial or spinal thickening of the dura mater. We report three cases of hypertrophic pachymeningitis. All these patients presented symptoms such as back pain, paraparesis, and bladder-bowel disturbance. The cases of hypertrophic pachymeningitis include infections such as tuberculosis, fungal and meningococcal meningitis, and autoimmune diseases such as rheumatoid arthritis, Wegener's granulomatosis, and sarcoidosis.
Serologic test results for RA factor were positive in two patients, and no arthritis was found. One patient was diagnosed as meningitis, which was considered to be a field disease. MRI scan revealed marked dural thickening with circumference. It was hypointense on both T1 and T2WI, and contrast enhancement was prominent. All patients were successively cured by steroid therapy. The patients showed initially good response to steroid therapy, but in one patient, symptoms recurred when the steroid dosage was reduced.
Laminectomy and markedly thickened dura compression were performed, and the cord was noted. This was partially excised for the purpose of curing and diagnosis. Echo proved useful for the diagnosis of hypertrophic pachymeningitis.