Idiopathic Hypertrophic Pachymeningeal Lesions

Nine patients with intracranial pachymeningeal thickening and enhancement on magnetic resonance imaging (MRI) completed a short-term clinical and MRI follow-up study. Based on clinical pictures, 4 of them were found to have spontaneous intracranial hypotension (SIH) and the remaining 5 had idiopathic intracranial pachymeningitis (IIP). Both groups were compared regarding their clinical and MRI characteristics. In 4 patients with SIH, gadolinium-enhanced T1-weighted images (WI) showed a diffuse and even enhancement of the entire intracranial and spinal dura mater. These thickened dura was slightly hyperintense on T2-WI. They had a favorable prognosis. In 2 patients with IIP, MRI demonstrated a relatively focal and even thickening and enhancement of the intracranial dura which was slightly hyperintense with a central hypointense area on T2-WI. These patients showed a very favorable course with or without steroid pulse therapy. In the remaining 3 patients with IIP, MRI depicted a focal, uneven enhancement of the intracranial dura which was relatively hypointense on T2-WI. Two of them with prolonged symptoms had a remitting and relapsing course, and 1 had a favorable outcome. In spite of current limitations in identifying the underlying causes of idiopathic pachymeningeal abnormalities, MRI can characterize the different patterns of pachymeningeal thickening. These findings may also correlate with the clinical picture and may be useful in predicting the response to treatment and prognosis.

[1]  B. Lam,et al.  Visual loss from idiopathic intracranial pachymeningitis , 1994, Neurology.

[2]  A. Mamelak,et al.  Idiopathic hypertrophic cranial pachymeningitis. Report of three cases. , 1993, Journal of neurosurgery.

[3]  G. Krol,et al.  MRI changes in intracranial hypotension , 1993, Neurology.

[4]  W. Dillon,et al.  Dural enhancement and cerebral displacement secondary to intracranial hypotension , 1993, Neurology.

[5]  T. Naidich,et al.  Spontaneous intracranial hypotension with pachymeningeal enhancement on MRI , 1992, Neurology.

[6]  T. Yamashima,et al.  Gadolinium-DTPA enhancement of dural structures on MRI after surgery. , 1992, Neurochirurgia.

[7]  Gerber Ma,et al.  Intracranial inflammatory pseudotumor. , 1992 .

[8]  M. Gerber,et al.  Intracranial inflammatory pseudotumor. , 1992, Clinical neuropathology.

[9]  M. Jacobs,et al.  Spontaneous intracranial hypotension. An uncommon and underrecognized cause of headache. , 1991, The Western journal of medicine.

[10]  K. Hasuo,et al.  Abnormality in the cavernous sinus in three patients with Tolosa-Hunt syndrome: MRI and CT findings. , 1990, Journal of neurology, neurosurgery, and psychiatry.

[11]  M. Norenberg,et al.  Multifocal fibrosclerosis with hypertrophic intracranial pachymeningitis , 1989, Neurology.

[12]  I. Schwartz,et al.  Meningeal nodules with features of extranodal sinus histiocytosis with massive lymphadenopathy. , 1989, The American journal of surgical pathology.

[13]  C. Marsault,et al.  Hypertrophic cranial pachymeningitis: assessment with CT and MR imaging. , 1989, AJNR. American journal of neuroradiology.

[14]  M. Modic,et al.  Dural carcinomatosis: MR demonstration. , 1987, Journal of computer assisted tomography.

[15]  B. Blumenkopf,et al.  Meningeal neurosarcoidosis mimicking convexity en-plaque meningioma. , 1986, Surgical neurology.

[16]  K. Sethi,et al.  Dural sarcoidosis presenting with transient neurologic symptoms. , 1986, Archives of neurology.

[17]  M. Wall,et al.  Neurosarcoidosis involving optic nerves and leptomeninges: computed tomography findings. , 1986, The Journal of computed tomography.

[18]  E. Jones,et al.  Pachymeningitis cranialis hypertrophica. , 1985, Journal of neurology, neurosurgery, and psychiatry.

[19]  K. Hongo,et al.  Chronic meningitis with marked unilateral tentorial pachymeningitis. , 1985, Surgical neurology.

[20]  M. Salcman,et al.  Neurosarcoidosis: a review of the rarer manifestations. , 1981, Surgical neurology.

[21]  L. Weatherbee,et al.  Hypertrophic granulomatous cranial pachymeningitis causing progressive blindness in a chronic dialysis patient. , 1975, Journal of neurology, neurosurgery, and psychiatry.

[22]  G. B. Hassin,et al.  SYPHILITIC CEREBRAL HYPERTROPHIC PACHYMENINGITIS: Clinicopathologic Studies in a Case , 1940 .