Hypertrophic pachymeningitis

An MRI with thick dura and lots of contrast enhancement all around the head – this is the opening to a broad differential. Generally speaking, you have to differentiate between low pressure and inflammatory changes – so a spinal tap helps a lot and should be done soon. If inflammatory you face on of the various secondary causes of hypertrophic pachymeningitis or the idiopathic form (as in our case). There is good german article on the subject from 2006 and not much has been published on the subject apart from case reports.

For locals: in my folder there is a ppt presentation of a case of granulomatous idiopathic hypertrophic pachymeningitis…

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