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Washington University Experience | MISCELLANEOUS | Rheumatoid Nodule - Pachymeningitis - Odontoid subluxation | 6A0 Case 6 History
Case 6 History (AANP DSS 1981, Case 5) ---- This 68 year old man presented with complaints of bilateral fluctuating deafness and left-sided head pain. Ten months later, he was admitted with an acute illness involving abnormal limb movements which may have been seizures, and an acute decrease in level of consciousness. This was associated with fever and neck stiffness, and the spinal fluid showed a pleocytosis with lymphocyte predominance. Investigation failed to reveal an infective agent and no response to a wide range of antibiotics. He only improved to hydrocortisone treatment. Attempts to reduce the steroid therapy resulted in recurrence of his acute symptoms, and he was maintained on long-term steroid therapy. Fourteen months after his acute illness, he developed a perforated duodenal ulcer which was surgically treated. He remained in a long-term care facility until he died of a massive pulmonary embolus. At necropsy, the falx cerebri and the dura below the frontal poles and the left temporal and parietal lobes was slightly thickened and adherent to the brain. Fibrous thickening was also noted in the tentorium and roof of the anterior 4th ventricle. An H&E section from the falx cerebri was provided.
