Presentation
Past history of carcinoma of the breast. Now right hand numbness.
Patient Data
Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.
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Pre and post contrast imaging performed but only post contrast images shown.
Subtle but definite enhancing extra-axial mass overlying the left frontal lobe
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MRI shows a more extensive smooth but variable thickness dural enhancement/mass overlying the left hemisphere with mass effect
Bone scan for staging of cancer
Note subtle but definite abnormal isotope accumulation in the left fronto-parietal region at the site of dural thickening
Case 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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