Hypertrophic pachymeningitis

Hypertrophic pachymeningitis is a condition where there is localized inflammatory thickening of the dura. On imaging, it presents as a localized, multiple, or diffuse enhancing dural thickening commonly forming masslike lesions. 

Can have a multitude of presentations. Cranial nerve palsies are common.

It can result from a number of causes which include:

When no cause is identified it is termed idiopathic hypertrophic pachymeningitis.

  • shows localized or less often diffuse dural thickening
  • at times can depict mass like thickening where 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

General imaging differential considerations include:

Infections of the central nervous system
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rID: 10824
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Cases and figures

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