hypertrophe 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 mass-like lesions.

Clinical presentation

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

Pathology

Etiology

It can result from a number of causes which include:

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

Radiographic features

MRI
  • shows localized, or less often, diffuse dural thickening
  • at times can depict mass-like thickening when it is termed tumefactive hypertrophic pachymeningitis

Signal characteristics include:

  • T1: thickened areas are hypointense to brain parenchyma on unenhanced T1 images
  • T1 C+ (Gd): shows dural enhancement
  • T2: thickened areas are hypointense to brain parenchyma

Differential diagnosis

General imaging differential considerations include:

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