Focal status epilepticus as a manifestation of idiopathic hypertrophic cranial pachymeningitis

Irene Navalpotro-Gómez, Rosa María Vivanco-Hidalgo, Elisa Cuadrado-Godia, Santiago Medrano-Martorell, Francisco Alameda-Quitllet, Gloria Villalba-Martínez, Jaume Roquer

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    Abstract

    © 2016 Elsevier B.V. All rights reserved. Background Idiopathic hypertrophic cranial pachymeningitis (IHCP) is an uncommon disease of unknown etiology characterized by thickening of the cerebral dura mater with possible associated inflammation. The most frequently described clinical symptoms include headache, cranial nerve palsy, and cerebellar dysfunction. Epilepsy and/or status epilepticus as main presentation is very uncommon. Case presentation Two consecutive cases are presented of patients manifesting focal status epilepticus secondary to IHCP, with clinical, laboratory [blood test and cerebrospinal fluid (CSF) analysis], neuroradiologic [magnetic resonance imaging (MRI) at 3 Tesla and digital subtraction angiography (DSA)], and therapeutic data. One patient underwent meningeal biopsy; pathology findings are also included. Corticosteroid therapy resulted in clinical improvement in both cases, and neuroimaging showed decreased abnormal morphology, compared to initial findings. Conclusion In the diagnostic approach to focal status epilepticus or epilepsy, IHCP must be considered a potential, although extremely infrequent, cause. Anti-inflammatory treatment is an effective addition to antiepileptic drug therapy in patients with IHCP.
    Original languageEnglish
    Pages (from-to)232-236
    JournalJournal of the Neurological Sciences
    Volume367
    DOIs
    Publication statusPublished - 15 Aug 2016

    Keywords

    • Cerebral edema
    • Dural enhancement
    • Focal seizures
    • Idiopathic hypertrophic pachymeningitis
    • Status epilepticus

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    Navalpotro-Gómez, I., Vivanco-Hidalgo, R. M., Cuadrado-Godia, E., Medrano-Martorell, S., Alameda-Quitllet, F., Villalba-Martínez, G., & Roquer, J. (2016). Focal status epilepticus as a manifestation of idiopathic hypertrophic cranial pachymeningitis. Journal of the Neurological Sciences, 367, 232-236. https://doi.org/10.1016/j.jns.2016.06.025