Figure 5. A patient with focal pachymeningitis and Tolosa-Hunt-like syndrome A patient with focal pachymeningitis and Tolosa-Hunt-like syndrome (A) Neuroimaging.

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Presentation transcript:

Figure 5. A patient with focal pachymeningitis and Tolosa-Hunt-like syndrome A patient with focal pachymeningitis and Tolosa-Hunt-like syndrome (A) Neuroimaging studies in patient PT-2 demonstrate the presence of pachymeningeal and leptomeningeal enhancement (blue arrows) localized in the medial aspect of the left middle cranial fossae extending to the orbital apex with involvement of the dural margin of the left cavernous sinus, Meckel cave, and foramen ovale. Enhancement of the left optic nerve dura (yellow arrow) is also noted in the March 18, 2014, MRI. (B) Neuroimaging studies following 5 weeks of antibiotic treatment (December 1, 2014) show decreased meningeal and dural enhancement along the anteromedial left temporal lobe margin and tentorial leaflet as well as optic nerve dural sheath. (C) Histopathologic studies of the dura and adjacent bone show chronic inflammation comprising lymphocytes, macrophages, and a few plasma cells (hematoxylin & eosin stain). Steven L. Salzberg et al. Neurol Neuroimmunol Neuroinflamm 2016;3:e251 © 2016 American Academy of Neurology