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At the time the article was created Yuranga Weerakkody had no recorded disclosures.View Yuranga Weerakkody's current disclosures
At the time the article was last revised Frank Gaillard had the following disclosures:
- Biogen Australia Pty Ltd, Investigator-Initiated Research Grant for CAD software in multiple sclerosis: finished Oct 2021 (past)
These were assessed during peer review and were determined to not be relevant to the changes that were made.View Frank Gaillard's current disclosures
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
- T1: thickened areas are hypointense to brain parenchyma 6
- T1 C+ (Gd): dural enhancement
- T2: thickened areas are hypointense to brain parenchyma 6
Treatment and prognosis
Management depends on the underlying cause, and includes immunosuppression in idiopathic cases 7.
General imaging differential considerations include:
- 1. Kazem IA, Robinette NL, Roosen N et-al. Best cases from the AFIP: idiopathic tumefactive hypertrophic pachymeningitis. Radiographics. 25 (4): 1075-80. doi:10.1148/rg.254045207 - Pubmed citation
- 2. Nemzek W, Postma G, Poirier V et-al. MR features of pachymeningitis presenting with sixth-nerve palsy secondary to sphenoid sinusitis. AJNR Am J Neuroradiol. 1995;16 (4): 960-3. AJNR Am J Neuroradiol (abstract) - Pubmed citation
- 3. Martin N, Masson C, Henin D et-al. Hypertrophic cranial pachymeningitis: assessment with CT and MR imaging. AJNR Am J Neuroradiol. 10 (3): 477-84. AJNR Am J Neuroradiol (abstract) - Pubmed citation
- 4. Friedman D, Flanders A, Tartaglino L. Contrast-enhanced MR imaging of idiopathic hypertrophic craniospinal pachymeningitis. AJR Am J Roentgenol. 1993;160 (4): 900-1. AJR Am J Roentgenol (citation) - Pubmed citation
- 5. Jones SE, Belsley NA, Mcloud TC et-al. Rheumatoid meningitis: radiologic and pathologic correlation. AJR Am J Roentgenol. 2006;186 (4): 1181-3. doi:10.2214/AJR.05.0859 - Pubmed citation
- 6. Friedman DP, Flanders AE. Enhanced MR imaging of hypertrophic pachymeningitis. AJR Am J Roentgenol. 1997;169 (5): 1425-8. AJR Am J Roentgenol (abstract) - Pubmed citation
- 7. Abrantes F, Moraes M, Rezende Filho F, Pedroso J, Barsottini O. A Clinical Approach to Hypertrophic Pachymeningitis. Arq Neuro-Psiquiatr. 2020;78(12):797-804. doi:10.1590/0004-282x20200073 - Pubmed