Recurrent cranial neuropathy as a clinical presentation of idiopathic inflammation of the dura mater: a possible relationship to Tolosa-Hunt syndrome and cranial pachymeningitis

We report 14 patients with idiopathic recurrent cranial neuropathy, in whom multiple cranial nerves were involved recurrently, either at the same or different times, and appeared bilaterally. Oculomotor nerve involvement was most frequent, while the abducens and facial nerves were the next most frequent. Clinical courses were benign and not progressive, and the symptoms responded well to corticosteroids. Ten patients developed Tolosa-Hunt syndrome during the course of their illness. Laboratory findings and CSF were normal. MRI and CT studies were unremarkable, except for an asymmetric appearance of the cavernous sinus in some patients. One patient showed focal hypertrophic pachymeningitis in the posterior fossa in MRI. We discuss the relationship of the idiopathic recurrent cranial neuropathy with disorders characterized by inflammation of the dura mater, such as Tolosa-Hunt syndrome and cranial pachymeningitis.