Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/71597
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Type: Journal article
Title: A multi-centre case series investigating the aetiology of hypertrophic pachymeningitis with orbital inflammation
Author: Cannon, P.
Cruz, A.
Carolina, P.
Mastropietro, D.
Chahud, F.
Bilyk, J.
Selva-Nayagam, D.
Prabhakaran, V.
Citation: Orbit, 2011; 30(2):64-69
Publisher: Taylor & Francis The Netherlands
Issue Date: 2011
ISSN: 0167-6830
1744-5108
Statement of
Responsibility: 
Paul S. Cannon, Antonio A.V. Cruz, Carolina T. Pinto, Dante A. Mastropietro, Fernando Chahud, Jurij R. Bilyk, Dinesh Selva and Venkatesh C. Prabhakaran
Abstract: INTRODUCTION: To describe our attempt in establishing a definitive diagnosis in patients with hypertrophic pachymeningitis in combination with orbital inflammatory disease and report on the outcome. MATERIALS AND METHODS: This was a retrospective case series of all patients presenting with hypertrophic pachymeningitis in association with orbital inflammation in 4 centres. Ophthalmic and neurological examination data, laboratory data, histology data, treatment plans and clinical outcome data were recorded. Patients underwent orbital/brain computed tomography and magnetic resonance imaging. RESULTS: Six patients were identified; the median age was 46.5 years. Headache was the commonest presenting symptom, followed by diplopia and reduced visual acuity. Three patients underwent orbital biopsy, 1 patient underwent dura mater biopsy, 1 patient underwent both and 1 patient underwent nasal biopsy. Four patients were diagnosed with Wegener granulomatosis and 2 patients with tuberculosis. Corticosteroid therapy was initiated in 4 patients, with steroid-sparing drugs added later. Two patients received anti-tuberculosis treatment and 1 patient was commenced on pulsed cyclophosphamide. On follow-up, 1 patient required an exenteration for a painful blind eye and 1 patient’s visual acuity remained at no perception to light. One patient had complete resolution of symptoms on treatment, 1 patient had persistent reduced visual acuity and 1 patient was lost to follow-up. CONCLUSION: We postulate that the combination of orbital inflammation and pachymeningitis is strongly suggestive of Wegener granulomatosis, although it may take a number of years to confirm. Tuberculosis should also be considered.
Keywords: Orbital inflammation; hypertrophic pachymeningitis; aetiology; Wegener's granulomatosis; Tuberculosis
Rights: Copyright © 2011 Informa Healthcare USA, Inc.
RMID: 0020117648
DOI: 10.3109/01676830.2010.539766
Appears in Collections:Opthalmology & Visual Sciences publications

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