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Tuberculous cranial pachymeningitis

From the Departments of Neurology (M.J.T., J.M.S., G.M.H.), Infectious Diseases & Microbiology (A.B.R.K.), and Pathology (M.Y.), Royal Prince Alfred Hospital; and the Department of Microbiology & Infectious Diseases (T.G.), Concord Repatriation General Hospital, Sydney, Australia.

Address correspondence and reprint requests to Dr. Matthew J. Thurtell, Department of Neurology, Royal Prince Alfred Hospital, Camperdown NSW 2050, Australia; e-mail: matthewt{at}icn.usyd.edu.au

We describe two immunocompetent patients with tuberculous cranial pachymeningitis. Both patients underwent biopsy after focal dural thickening was identified on MRI. Histopathologic examination of tissue revealed necrotizing granulomatous inflammation. PCR for Mycobacterium tuberculosis DNA was negative on CSF but positive on tissue. Both patients responded to antituberculous therapy. Although uncommon as a cause of cranial pachymeningitis, tuberculosis should be considered, since it responds well to treatment.

Disclosure: The authors report no conflicts of interest.

Received August 13, 2006. Accepted in final form October 16, 2006.