Tuberculous Hypertrophic Pachymeningitis

Tuberculous pachymeningitis is a rare disease that should be suspected in patients with chronic headaches, focal neurological signs, and magnetic resonance imaging (MRI) findings of dural thickening. We report the case of a 62-year-old male who presented with chronic headaches for over a year, progressive right-sided vision and hearing loss for six months, and progressive dysphagia for a month. On investigation, MRI showed dural thickening, cerebrospinal fluid showed lymphocytic pleocytosis with high protein and normal glucose levels, and biopsy of the dural matter showed necrotizing granulomas with Langhans giant cells. The patient responded well to antitubercular treatment and steroids. Follow-up MRI 24 months later showed almost complete resolution of meningeal enhancement. Though tuberculosis is an uncommon cause of pachymeningitis, it should be considered, as it responds well to treatment.