Case Report

ANCA-Negative Granulomatosis with Polyangiitis Presenting with Hypertrophic Cranial Pachymeningitis, Abducens Nerve Palsy, and Stenosis of the Internal Carotid Artery

Table 1

Characteristics of reported cases with granulomatosis with polyangiitis (GPA) accompanied by cerebrovascular disorder.

AuthorYearAge/sexClinical featuresCerebrovascular involvementHCPNoseEarEyeRenalLungMPO-ANCAPR3-ANCATreatmentOutcome

Cruz and Segal [8]199771/MHeadache, nausea, CN VIISAH++++ndmPSL, CYImproved

Nagashima et al. [11]200053/FParaplagia, fever, CN I, II, VI, VII, VIIIICA stenosis, loss of ophthalmic artery++++++PSL, AZPDead

Thajeb and Tsai [12]200165/MHeadache, hyperesthesia, fever, CN III, VICA stenosis, cavernous sinus syndrome+++++PSL, CYImproved

Sivakumar and Chandrakantan [5]200249/MHemiparesis, seizure, fever, CN XInfarction of pons and temporal lobe++++nd+CYImproved

Fam et al. [3]200363/FHeadache, CN IINarrowing of ophthalmic artery++++PSL, CY, MTXImproved

Weijtens et al. [13]200445/FHearing loss, Horner’s syndrome, CN VI, XCavernous sinus involvement++++DEX, AZPImproved

Takei et al. [9]200434/MHeadache, feverSAH++++mPSL, PSL, CYImproved

Peng and Wang [6]201258/MHeadache, ataxia, motor weakness, meningeal signs, CN III, VI, IX, XCerebral infarction++++++mPSL, PSL, CYImproved

Yajima et al. [7]201575/MHeadache, hemiparesis, loss of consciousness, hoarseness, hearing loss, feverHemorrhagic infarction+++++nd+Frontal lobectomy, mPSL, PSL, AZPImproved

Present case201759/MHeadache, CN VIICA stenosis+++mPSL, PSL, CY, AZPImproved

CN: cranial nerve affected, SAH: subarachnoid hemorrhage, ICA: internal carotid artery, HCP: hypertrophic cranial pachymeningitis, +: affected or positive, −: not affected or negative, nd: not detected, mPSL: methylprednisolone, CY: cyclophosphamide, PSL: prednisolone, AZP: azathioprine, MTX: methotrexate, DEX: dexamethasone.