Hypertrophic pachymeningitis
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Hypertrophic pachymeningitis is a condition where there is localised inflammatory thickening of the dura. On imaging, it presents as a localised, multiple, or diffuse enhancing dural thickening commonly forming mass-like lesions.
Clinical presentation
Can have a multitude of presentations. Cranial nerve palsies are common.
Pathology
Aetiology
It can result from a number of causes which include:
- infective
-
inflammatoryhaematological/inflammatory - neurosarcoidosis
- haemodialysis
- mucopolysaccharidoses 6
When no cause is identified it is termed idiopathic hypertrophic pachymeningitis.
Radiographic features
MRI
- shows localised, or less often, diffuse dural thickening
- at times can depict mass-like thickening when it is termed tumefactive hypertrophic pachymeningitis 1
Signal characteristics include:
- T1: thickened areas are hypointense to brain parenchyma on unenhanced T1 images 6
- T1 C+ (Gd): shows dural enhancement
- T2: thickened areas are hypointense to brain parenchyma 6
Differential diagnosis
General imaging differential considerations include:
- meningeal metastases
- meningeal involvement with CNS lymphoma
- multiple meningiomas including lymphoplasmacyte-rich meningioma
- intracranial involvement with Erdheim Chester disease
-<p><strong>Hypertrophic </strong><strong>pachymeningitis</strong> is a condition where there is localised inflammatory thickening of the <a title="Dura mater" href="/articles/dura-mater">dura</a>. On imaging, it presents as a localised, multiple, or diffuse enhancing dural thickening commonly forming mass-like lesions. </p><h4>Clinical presentation</h4><p>Can have a multitude of presentations. Cranial nerve palsies are common.</p><h4>Pathology</h4><h5>Aetiology</h5><p>It can result from a number of causes which include:</p><ul>- +<p><strong>Hypertrophic </strong><strong>pachymeningitis</strong> is a condition where there is localised inflammatory thickening of the <a href="/articles/dura-mater">dura</a>. On imaging, it presents as a localised, multiple, or diffuse enhancing dural thickening commonly forming mass-like lesions. </p><h4>Clinical presentation</h4><p>Can have a multitude of presentations. Cranial nerve palsies are common.</p><h4>Pathology</h4><h5>Aetiology</h5><p>It can result from a number of causes which include:</p><ul>
-<li>inflammatory<ul>- +<li>haematological/inflammatory<ul>
- +<li><a title="Rosai-Dorfman disease" href="/articles/rosai-dorfman-disease">Rosai-Dorfman disease</a></li>
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