Nontuberculous Antineutrophil Cytoplasmic Antibody–Positive Pachymeningitis Presenting as High Cervical Myelopathy

High cervical myelopathy is a common entity and often encountered in clinical practice. Various pathologies can present with this symptomatology. Detailed history and a meticulous neurological examination can help us differentiate and rule out some of the close differentials. Non tuberculous ANCA positive pachymeningitis is a rare entity and a diagnosis of exclusion or following histopathological confirmation. Here we describe a case of high cervical myelopathy, the presentation, imaging and the various differentials considered and how we arrived at the diagnosis.