Immune-Mediated Hypertrophic Pachymeningitis and its Mimickers: Magnetic Resonance Imaging Findings

Case of infiltrative optic neuropathy with hypertrophic pachymeningitis as a manifestation of en plaque meningioma

“…An exception to this rule, en plaque meningiomas are rare primary meningothelial tumours with a morphological configuration of flatter, carpet-like lesions that infiltrate the dura and may invade the underlying bone. On imaging, they present with prominent signs of hyperostosis (more than expected for a typical meningioma) with intense contrast enhancement on T1-weighted MRI sequences and corresponding hypointensity on T2-weighted sequences 3 6. Primary dural lymphoma is a relevant neoplastic differential diagnosis in these cases.…”

“…HP is caused by fibrosis of the cranial or spinal dura mater due to an inflammatory process, which can be differentiated into idiopathic or secondary based on its aetiology. Secondary causes of HP include infectious diseases such as tuberculosis and syphilis; autoimmune diseases such as granulomatous with polyangiitis (GPA), neurosarcoidosis and IgG4-related disease; and neoplasms, particularly dural lymphoma and en plaque meningioma 2 3. There are also case reports of systemic lupus erythematosus (SLE), giant-cell arteritis, relapsing polychondritis, Behçet’s disease and Sjögren syndrome associated with HP 2…”

Diagnosis and treatment status of suprasellar optic pathway cavernous malformations

“… 2 Considering the patient’s symptoms and site of onset, differential diagnoses should include diseases such as craniopharyngioma, optic neuritis, pituitary adenoma, germ cell tumors, optic nerve glioma, aneurysm, and sarcoidosis (chiasmal involvement due to basal leptomeningitis). 12 On MRI, lesions affecting the optic nerve or tract typically manifest as thickened nerves with an increased diameter, whereas lesions involving the chiasm or hypothalamus are characterized by focal and round suprasellar masses.…”

Magnetic resonance imaging findings in central nervous system tuberculosis: A pictorial review

“…However, isolated pachymeningeal thickening creates a diagnostic dilemma. Differential diagnosis of isolated pachymeningeal thickening is neurosarcoidosis, en-plaque meningioma, idiopathic hypertrophic pachymeningitis, autoimmune diseases with CNS involvement (Granulomatosis with polyangiitis, rheumatoid arthritis) [ 5 , 41 ]. Parenchymal tuberculosis: Parenchymal tuberculosis can present as tuberculoma, disseminated/miliary tuberculomas, tuberculous abscess, tuberculous cerebritis, rhombencephalitis, or encephalopathy.…”

“…However, isolated pachymeningeal thickening creates a diagnostic dilemma. Differential diagnosis of isolated pachymeningeal thickening is neurosarcoidosis, en-plaque meningioma, idiopathic hypertrophic pachymeningitis, autoimmune diseases with CNS involvement (Granulomatosis with polyangiitis, rheumatoid arthritis) [ 5 , 41 ].…”