Abstracts

Idiopathic intracranial hypertrophic pachymeningitis (IIHP) is an uncommon disorder that causes a localized or diffuse thickening of the dura mater and at the onset most of the patients have chronic daily headache, associated with or without neurologic manifestation such as cranial nerve palsies, cerebellar ataxia, and neuro-opthalmic complications. To our knowledge, there are no reported cases of IIHP with intractable seizures unresponsive of conventional anticonvulsants. We describe two men with refractory seizures which remitted after steroid therapy. 2 case reports A 45-year old man admitted 6-year history of chronic daily headache and facoal seizure of left arm. MRI revealed diffuse thickening and enhancement of the right frontotemporal dura mater. Histopathological study provided reactive gliosis and chronic inflammation. Carbamazepine was tried, but seizure control was failed. The patient showed a good response to steroid therapy, seizure was controlled. Later, when steroid tapered, he developed aggravation of seizure. A 62-year old man presented recurrent complex partial seizures and left hemiparesis. MRI showed a linear contrast enhancement on the gyral surfaces of right temporoparietal region. Interictal electroencephalogram((EEG) showed left temporal (T3) sharp waves. Seuzures were not response to Valproic acid and Carbamazepine. But steroid resulted in seizure control. IIHP has been linked to medically intractable partial seizure and refractory seizure is also controlled by steroid therapy as other clinical signs. Pathophysiological mechanisms seem to be inflammatory perivascular infiltration that plays an important role in cortical irritative symptomatology. Therefore, Corticosteroid should be considered in the treatment of seizures which underlying mechanism is inflammatory proccess.