Pachymeningeal enhancement
From IDWiki
Background
- Refers to MRI enhancement of the dura and outer layer of arachnoid following contrast enhancement
- Also known as dura-arachnoid enhancement
- A small amount of enhancement is found in 50% of normal people
Differential Diagnosis
- Intracranial hypotension, which typically demonstrates diffuse, smooth, wave-like pattern of enhancement in the temporal and frontal base
- Meningitis, including bacterial, viral, fungal, and tuberculous, though they are more likely to present with leptomeningeal enhancement
- Intracranial neoplasms
- Extra-axial: meningioma and calvarial lesions, which typically show focal pachymeningeal enhancement
- Intra-axial: primary CNS malignancy amd metastases, which show varied pachymeningeal and leptomeningeal enhancement
- Post-procedural or post-operative changes, particularly following craniotomy, intrathecal infusions, shunt placement, or lumbar puncture, which typically shows diffuse, smooth, enhancement, sometimes limited to the side of the procedure
- Idiopathic pachymeningitis
- Cerebral venous thrombosis
- Neurosarcoidosis
- Vogt-Koyanagi-Harada syndrome
- Extramedullary hematopoiesis
- Rheumatoid arthritis
- Granulomatosis with polyangiitis
Further Reading
- Pachymeningeal enhancement-a comprehensive review of literature. Neurosurg Rev. 2015;38(4):649-59. doi: 10.1007/s10143-015-0646-y
