M Lowden, A Ahmed
all clinical neurology, all neuro otology, intra cranial pachymeningitis, wegener’s granulomatosis
M Lowden, A Ahmed. Wegener’s Granulomatosis presenting with multiple cranial neuropathies.. The Internet Journal of Neurology. 2008 Volume 11 Number 2.
A 41–year-old man had headaches, hearing loss, and left facial palsy for five months. Examination was remarkable for left seventh nerve palsy, left sided hearing loss and hemi tongue atrophy. MRI showed left cerebellopontine angle dural thickening.(Figure1and 2). Laboratory studies (CSF and blood) were unremarkable for an infectious, neoplastic and autoimmune etiology except for an elevated Anti-neutrophil cytoplasmic antibody titer. A dural biopsy showed chronic inflammation with granuloma formation. He was started on prednisone with plans to start immunosuppresants as outpatient.
Wegener’s Granulomatosis can present with multiple cranial neuropathies as initial clinical manifestation1 due to focal meningeal involvement 2.