Unilateral optic disc swelling associated with idiopathic hypertrophic pachymeningitis: a rare cause for a rare clinical finding

Description

A woman aged 28 years presented with a 1-year history of left-sided headache. The headache was continuous and interfering with activities of daily living. She did not have vomiting or visual obscurations. She developed left-sided sixth nerve palsy and facial numbness and was referred to us. On clinical evaluation, she had left-sided sensorineural deafness. Fundus examination showed optic disc swelling on the left side and a normal right eye (figure 1A). MRI brain with contrast showed features of hypertrophic pachymeningitis predominantly affecting the left side involving the tentorium and cerebral cortex (figure 1B, E) and encasing the cavernous sinus (figure 1C, D). Optic nerve sheath dilation was evident on the left side (figure 1F, G). Blood counts, serum biochemical tests and erythrocyte sedimentation rate were normal. The serum was negative for rheumatoid factor, antinuclear antibodies and antidouble-stranded DNA. The...

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