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Letters to the Editor
September 2000

Levodopa Toxicity in Parkinson Disease

Arch Neurol. 2000;57(9):1380-1383. doi:

In 1993, two colleagues and I published reports of cases of hypertrophic cranial pachymeningitis.1 Among them was that of a woman (case 2) who, in addition to imaging and biopsy findings of pachymeningitis, had the symptoms and biopsy findings of temporal arteritis. Because of concerns that one or the other of the diagnoses might be in error, the pathology slides of the temporal artery and the meninges were reviewed, and the pathologists remained convinced that the original diagnoses were correct. We concluded that our woman's case was one that broke the law of medical parsimony and that the two disorders were associated in her merely by chance. The recent report in this journal by Joelson et al2 of a patient with the same combination of pachymeningitis and temporal arteritis makes it very likely that we were in error. Of interest, giant cells were not seen in either patient's temporal artery biopsy samples, and both of the meningeal biopsy specimens showed nongranulomatous inflammation without true arteritis. Do these patients have a previously undescribed disease? Is pachymeningitis a manifestation of temporal arteritis? For the moment these questions cannot be answered, but it would seem appropriate for clinicians who encounter cases of idiopathic hypertrophic pachymeningitis to perform temporal artery biopsies and to review magnetic resonance imaging scans of patients with temporal arteritis for evidence of meningeal thickening.

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