Idiopathic hypertrophic pachymeningitis (IHP) causing headache in a young female.

Abstract

Hypertrophic pachymeningitis (HP) is characterised by thickening of the cranial or spinal dura mater, and it encompasses idiopathic and secondary forms. Later is linked to infections, inflammatory conditions, and autoimmune disorders. This rare condition presents with a myriad of neurological manifestations, including headaches, cranial nerve palsies, and visual disturbances. A South-Asian woman in her mid-thirties presented with a three-month history of left-sided headache, double vision, and facial numbness. Neuroimaging revealed diffuse thickening of the dura mater, suggestive of hypertrophic pachymeningitis (HP). Diagnostic workup excluded infectious and autoimmune causes, categorising the condition as idiopathic. Treatment with corticosteroids led to significant improvement in her symptoms. HP is a rare cause of headache in young patients, and diagnosis relies on neuroimaging and CSF analysis, necessitating the exclusion of secondary causes through comprehensive evaluation. Treatment varies based on the underlying aetiology. Corticosteroids remain the first-line drug for idiopathic cases.

Funding: None declared.