Pachymeningeal metastasis from breast cancer

Discussion:

Dural or pachymeningeal metastases are rare.  Breast and prostate cancer are the most likely primary sites.  As in this case, MRI shows much more extensive dural thickening than CT. 

Always be aware that such tumor can obstruct cortical veins or major venous sinuses leading to venous infarction.   The major differential is obviously meningioma but should include an infective process such as TB as well as post-operative change following craniotomy.  

Spontaneous intracranial hypotension causes smooth bilateral dural thickening.   Extra-axial collections may enhance around the rim but not within the central fluid.

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