Hypertrophic pachymeningitis

Last revised by Francis Deng on 15 Jul 2024

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

The clinical presentation may be varied 7. Common clinical features include headache and cranial nerve palsies 7.

It can result from a number of causes which include 5-8:

  • localized, or less often, diffuse dural thickening

  • may uncommonly depict mass-like thickening, termed tumefactive hypertrophic pachymeningitis 1

Signal characteristics:

  • T1: thickened areas are hypointense to brain parenchyma 6

  • T1 C+ (Gd): dural enhancement

  • T2: thickened areas are hypointense to brain parenchyma 6

Management depends on the underlying cause, and includes immunosuppression in idiopathic cases 7.

General imaging differential considerations include:

Cases and figures

  • Case 1: cause unknown
  • Case 2: cause unknown
  • Case 3: neurosarcoidosis
  • Case 4: GPA

Imaging differential diagnosis

  • Multiple meningiomas
  • Erdheim Chester disease
  • Lymphoplasmacyte-rich meningioma
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