A Rare Case of Spinal Hypertrophic Pachymeningitis That Caused Tetraplegia After Myelography

Hypertrophic pachymeningitis (HP) is a rare inflammatory disease that causes the thickening of the dura mater. Its etiology is mainly classified as idiopathic or secondary, and autoimmune disease is one of the main causes of secondary HP. Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis and IgG4-related disease are common among autoimmune diseases. Here we present a case of spinal HP in which the patient showed spinal shock and neurological symptoms deteriorated after myelography. Since the patient was sedated without caution of the neck posture, the HP itself compressed the spinal cord, which led to the tetraplegia. To our knowledge, this is the first case report of such an entity. Our case highlights the risk of sedation for patients who have hypertrophic lesions of the dura mater.