A 70-year-old female presented with an 8 month history of upper back pain. She had initially been treated with steroids without any improvement. After the steroids were discontinued, she developed gait disturbance and dysesthesia in her hands and legs. On admission, neurological examination revealed tetraparesis with pyramidal signs in both extremities. Myelogram and spinal CT showed narrowing of the subarachnoid spaces from C7 to T3, from T7 to T8 and from T10 to T11. A gadolinium-DTPA enhanced T1-weighted magnetic resonance imaging revealed marked enhancement of the dura in areas consistent with abnormalities shown by the myelogram. Laminoplasty of C6 to T2 and laminectomy of T6 to T8 were performed. Markedly thickened dura compressing the cord was noted, then this was partially excised and replaced by a patch graft. The pathological diagnosis was a nonspecific chronic inflammation. After surgery, the patient's symptoms disappeared. However with tapering off of steroids, her upper back pain reappeared. Therefore steroids were given orally on alternate days.
It is stressed that MRI with enhancement is the best method for diagnosis of hypertrophic pachymeningitis and removal of the affected dura and administration of steroids are suitable treatments for this disorder.