Application Of Pathological Biopsy In Hypertrophic Meningitis

Objective: To summarize 25 patients with HCP diagnosed and treated in Henan Provincial people's Hospital from January 2014 to August 2019.Through a retrospective study of the past medical history,clinical manifestations,blood system examination,cerebrospinal fluid examination,imaging data,treatment process and prognosis of 25 patients with hypertrophic pachymeningitis,combined wi th the previous literature,the clinical and pathological features of(HCP)in hypertrophic pachymeningitis were analyzed in order to explore the application of pathological biopsy by neurologists in hypertrophic meningitis.Materials: and Methods: The clinical data of 25 patients with HCP diagnosed by Department of Neurology and Neurosurgery of Henan people's Hospital were collected retrospectively.the collected data included sex,age,concomitant disease,onset-diagnosis time,clini cal symptoms,laboratory examination,imaging results,pathological biopsy and treatment,prognosis and recurrence.Specific data collected include concomitant diseases: rheumatoid rheumatoid,multifocal fibrosclerosis,sarcoidosis,aplastic anemia,tumor,Wegener granuloma(Wegener 's granuloma)and so on.The time from onset to diagnosis.Clinical symptoms: headache,cranial nerve damage,cerebellar ataxia,epilepsy,abnormal mental behavior and other symptoms.Laboratory tests.Imaging related examination : including head CT and 1.5T or 3.0T MRI plain or enhanced MRI,magnetic resonance angiography(MRA),magnetic resonance venography(MRV),were used to describe the location and type of dura mater thickening,whether accompanied by venous sinus thrombosis,local edema and so on.Pathological biopsy(yes / no)treatment: including primary disease treatment,corticosteroids and immunosuppressant therapy(type and treatment dose,time).Outcome variables: follow-up of patients with symptom relief,follow-up of their medical records,head magnetic resonance reexamination can be divided into: cure,recurrence after cure, uncured,death.25 patients were studied with one arm,and the application of pathological biopsy in HCP was systematically described.Results: Among the 25 patients with HCP,there were 14 males and 11 females with a mean age of 49.04 ±14.72 years(range from 17 to 75 years).Course of disease: the course of disease ranges from 10 days to 14 years,and the average course of disease is 8.3 month s.There are 21 cases of chronic disease,accounting for 84%.Clinical symptoms: headache was found in 21 cases,headache was the first symptom in 19 cases,and the remaining symptoms were cranial nerve injury,epilepsy and cerebellar ataxia.Laboratory ex amination: blood WBC elevated in 5 cases,CRP elevated in 8 cases,Pc-ANCA positive in 2 cases,MPO positive in 1 case.Cerebrospinal fluid examination: of the 25 patients,23 underwent lumbar puncture,including increased cerebrospinal fluid pressure in 1 1 cases(47.8%),normal in 10 cases(43.5%)and decreased in 2 cases(8.7%);CSF bacteria count increased in 7 cases,all of which were not more than twice as normal.A mong them,Ig A was elevated in 5 cases,Ig G in 3 cases and Ig M in 2 cases.Imaging data: MR I showed dura mater thickening in all cases,diffuse thickening of the whole brain in 4 cases,accounting for 16%,focal thickening in 21 cases,and thickening sites in turn: frontal lobe,cerebral falx,parietal lobe,temporal lobe,occipital lobe,cer ebellar tentorium.The thickening site was consistent with the clinical symptoms.Pathological biopsy: among the 25 patients,3 cases underwent pathological biopsy,including 2 cases of craniotomy biopsy and 1 case of lung puncture biopsy,which were diagnosed as immune-related HCP,specific HCP and Wegener granulomatous granuloma-associated HCP,respectively.Prognosis: among the 25 patients,1 case died of lung cancer and 1 case refused treatment.A mong the remaining 23 cases,all the patients were treated with hormone pulse therapy and long-term hormone maintenance therapy,and the dose was gradually reduced.15 cases were improved and no recurrence occurred,8 cases had recurrence,including 4 cases of idiopathic HCP recurrence and 4 cases of secondary hormone therapy.Conclusion:most of the patients with HCP have chronic onset,most of them are aged from 40 to 60 years old,and there are more males than females.The main clinical manifestations are headache,cranial nerve damage,seizures and ataxia.The laboratory examination was not specific,and the dura mater was thickened and enhanced on MR I.Glucocorticoid is the main treatment,and immunosuppressant is used if necessary.Although pathological examination is the gold standard,because of its inva siveness and high cost,there is no specific reference for pathological biopsy in patients with HCP at home and abroad.This study puts forward the application of pathological biopsy in HCP for the first time.The main results are as follows:(1)for the p atients with simple headache as the only symptom,Mr enhancement showed diffuse hypertrophy or localized hypertrophy,and enhancement could be seen.Patients with suspected HCP,and single etiology can be directly treated with hormone pulse therapy and imm unosuppressant therapy.No need for pathological biopsy(2)Headache or single or multiple groups of cranial nerve dysfunction,Mr enhancement showed diffuse hypertrophy or localized hypertrophy,enhancement could be seen.Patients with suspected HCP,and single etiology can be directly treated with hormone pulse therapy and immunosuppressant therapy.Cranial nerve symptoms can not be relieved in time after 5 days.Neurosurgical decompression should be performed in time to save visual acuity and take samples for pathological examination,so as to provide basis for follow-up treatment.When visual impairment occurs when visual acuity is under pressure,the effectiveness of hormone therapy may be temporary,which is related to hormone reduction of optic nerve edema,and it is easy to recur after drug withdrawal.Surgery should be performed immediately to reduce optic nerve compression so as to save the residual vision.(3)If the focus is localized and nodular in HCP patients with epilepsy as the main symptom,the lesion can be resected by craniotomy to reduce the adhesion between hypertrophic dura mater and nerve,so as to prevent and treat refractory epilepsy.