Idiopathic hypertrophic spinal pachymeningitis with compressive myelopathy: a case report

IHSP cause symptoms by the spinal cord. We present a case of IHSP across the dura in a 78-year-old male patient. The visited the emergency department for right shoulder pain a month before admission, weakness in the right upper extremity a week before admission, and sudden quadriparesis on the day of admission. A neurological examination of the motor power of the extremities indicated grade IV quadriparesis and grade I hand grasp power in both hands. Hypoesthesia under the T1 dermatome was evaluated. Cervical magnetic resonance imaging (MRI) with gadolinium enhancement showed diffuse thickening of the anterior and posterior dura through the C2 to C5 levels, causing central canal stenosis and compressive myelopathy. Immediate decompressive laminoplasty was performed. A biopsy specimen of the thickened dura mater was obtained during surgery, and IHSP was diagnosed on the basis of the results of the pathological examination. High-dose steroid therapy was administered after decompressive surgery, and follow-up showed radiological improvement in the lesion area.