Hypertrophic pachymeningitis

Last revised by Frank Gaillard on 12 Sep 2023

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 5-7:

  • 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:

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Cases and figures

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