Idiopathic hypertrophic spinal pachymeningitis: a diagnostic challenge. Case report

César A. Almendárez-Sánchez, Department of Neurosurgery, Centro Médico Licenciado Adolfo López Mateos, Instituto de Salud del Estado de México, Toluca, State of Mexico, Mexico
Carlos Morales-Valencia, Department of Neurosurgery, Centro Médico Licenciado Adolfo López Mateos, Instituto de Salud del Estado de México, Toluca, State of Mexico, Mexico
Leonardo Álvarez-Vázquez, Department of Neurosurgery, Centro Médico Licenciado Adolfo López Mateos, Instituto de Salud del Estado de México, Toluca, State of Mexico, Mexico
Arturo de J. Gómez-Cano, Department of Neurosurgery, Centro Médico Licenciado Adolfo López Mateos, Instituto de Salud del Estado de México, Toluca, State of Mexico, Mexico
Antonio Sosa-Nájera, Department of Neurosurgery, Centro Médico Licenciado Adolfo López Mateos, Instituto de Salud del Estado de México, Toluca, State of Mexico, Mexico

Hypertrophic spinal pachymeningitis is an unusual disease. It may be idiopathic or secondary to other diseases. The main characteristics are chronic inflammation and hypertrophy of the spinal dura mater, with resulting neurological deficits such as sensory and motor alterations. Treatment by surgical decompression combined with systemic steroids has a positive impact. The objective is to report a clinical case of hypertrophic spinal pachymeningitis since it is an extremely rare and little-known entity. A 65-year-old female patient, whose condition began on August 1, 2022, with stabbing pain in the dorsal region, without irradiation, without predominance of time. Three months after the onset of his current condition, there was a decrease in strength in bilateral pelvic limbs 3/5, as well as hypoesthesia in the pelvic limbs. Contrast-enhanced magnetic resonance imaging of the spine is requested; all sequences are reviewed where the contrast-enhanced T1 sequence highlights a lesion that generates narrowing at the level of the thoracic spine with an increase in volume and enhancement of contrast medium from T2 to T10 in the anterior and posterior spinal region. A biopsy of the lesion was obtained, which in the pathology report was concluded as hypertrophic spinal pachymeningitis and treatment with steroids was started immediately. Hypertrophic spinal pachymeningitis is an extremely rare entity, and there is scarce information published in the literature about it. Therefore, making a timely diagnosis to select the most appropriate treatment for patients is important.

Keywords: Hypertrophic spinal pachymeningitis. Spinal cord. Meningioma. Upper motor neuron.