How is hypertrophic hard meningitis treated?
summary
Hypertrophic dural meningitis is a rare disease characterized by diffuse thickening of dura mater and fibrous inflammatory process. It can be divided into idiopathic and secondary, mainly manifested as headache, multi cranial nerve palsy, hemiplegia and epileptic seizures. Local or diffuse thickening of dura mater can be seen on MRI, and enhancement can be seen on enhanced scan. Corticosteroids and immunosuppressants are effective in the treatment of hypertrophic dural meningitis, If appear cerebral parenchyma or nerve compression symptom, need operation treatment more. So how to introduce hypertrophic hard meningitis to treat specifically below? I hope this problem can help some people.
How is hypertrophic hard meningitis treated?
First: drug treatment: according to the etiology of treatment is the basic principle. The treatment of secondary HP should be combined with the results of etiological examination and drug sensitivity test. For example, itraconazole, amphotericin 4 or fluconazole can be used in the treatment of Aspergillus flavus infection; Tuberculosis infection needs anti tuberculosis treatment; Other bacterial infections should be treated with antibiotics. If a certain bacterial infection is suspected, but there is no evidence of etiological examination, experimental treatment can also be used. Secondary HP is generally effective by the corresponding drug treatment, but the prognosis is not good when there is still inflammation. Idiopathic HP is associated with autoimmunity and can be treated with corticosteroids and immunosuppressants. Corticosteroids are usually treated with methylprednisolone, dexamethasone and hydrocortisone, and then gradually reduced. After corticosteroid treatment, the course of disease can have three outcomes: persistent remission, relapse of non corticosteroid dependence and relapse of corticosteroid dependence. For patients with relapsed corticosteroid dependence, corticosteroid therapy is still effective. When choosing immunosuppressant to treat idiopathic HP, cyclophosphamide and methotrexate are available, but the side effects are obvious. Some people think that although corticosteroid treatment is effective, it is easy to relapse and form dependence. After the use of high-dose hormone therapy combined with long-term immunosuppressive therapy, satisfactory clinical and imaging results have been achieved. There are also some patients with the use of two drugs are not good, that is related to the existence of different pathogenesis.
Second: surgical treatment: the dural local or diffuse hypertrophy is obvious, and the symptoms of brain parenchyma or nerve compression have appeared, so surgical treatment is needed. Craniotomy and decompression were performed in different parts of the skull, and the thickened dura mater was removed at the same time. Most patients were treated with corticosteroid or immunosuppressant to control the progress of the disease. After this treatment, the clinical and imaging manifestations of most patients were significantly relieved, and the condition could be stable for a long time. However, it was difficult to completely recover the clinical symptoms, and the degree of remaining neurological disorders was positively correlated with the course of disease before treatment.
Third: other treatments: there are also reports of nonspecific therapy such as dehydration (such as glycerin), lymphocyte depletion or radiotherapy, but the curative effect is not sure because of the lack of relevant data.
matters needing attention
In fact, if we can in hypertrophic hard meningitis did not appear before, very good prevention of the emergence of this disease is the best. Therefore, we need to recognize the etiology of hypertrophic dural meningitis. Finally, I wish those sick people can recover soon and live a happy life!
