Achondroplasia. Now headache and pins and needles in arms. No overseas travel. No seizures.
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A region of vividly enhancing extra-axial tissue is seen over the surface of the right parietal lobe with extension across the midline and superior sagittal sinus. There is extension into the sulci with adjacent edema / T2 signal change in the parietal lobe.
Patient went on to have a biopsy.
MICROSCOPIC DESCRIPTION:Paraffin sections show dense infiltration of dura by a mixed cellular infiltrate. This is composed predominantly of lymphocytes lacking atypical features as well as plasma cells and monocyte macrophages. There is proliferation of small caliber vascular channels with swollen lining endothelium. Granulomas are not identified. There is no evidence of haemophagocytosis by monocyte macrophages. No eosinophils are identified.
Immunohistochemistry shows the lymphocytic infiltrate is a mixture of B and T cells. No CD30+ cells are seen. There is no immunostaining for IgG4 or CD1a and EBER-CISH is negative. The features are of non-specific pacchymeningitis. No evidence of tumor is seen.
FINAL DIAGNOSIS: Non-specific pachymeningitis; no evidence of tumor seen.