Headache and Hypoglossal Nerve Palsy in a Child With Idiopathic Hypertrophic Pachymeningitis

A 16-year-old girl presented with 11 months of migrainous headaches. Two months prior she had a febrile upper respiratory infection and as it was resolving she noted that her tongue was numb and deviated to the right. Since then her headaches had begun to awaken her from sleep. Her examination was notable for a right hypoglossal nerve palsy (Fig. 1) without palatal weakness or trigeminal sensory examination findings. Her brain MRI revealed extensive gadolinium-enhancing pachymeningeal thickening predominantly involving the posterior convexities and posterior fossa (Fig. 2). Serum C-reactive protein and antineutrophil cytoplasmic antibodies were negative; Headache doi: 10.1111/head.13598 © 2019 American Headache Society Published by Wiley Periodicals, Inc. ISSN 0017-8748