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Hypertrophic cranial pachymeningitis involving dural sinuses: a pseudo signal-void appearance on MRI
1Ege University Medical School, Department of Radiology, Bornova, lzmir, Turkey.
Abstract:
A case of hypertrophic cranial pachymeningitis with an unusual and misleading manifestation is reported. CT detected calcified tentorium and superior sagittal sinus. MR imaging and MR angiography depicted tentorial thickening as well as occlusion of all major dural sinuses. Fibrocalcific occlusion of dural sinuses showed interestingly signal-void appearance on spin-echo images which could readily be interpreted as being patent sinuses.
Insights
A rare case of hypertrophic cranial pachymeningitis presented unusually. Imaging findings mimicked patent sinuses, potentially misdiagnosing this serious condition.
Area of Science:
- Neurology
- Radiology
- Pathology
Background:
- Hypertrophic cranial pachymeningitis (HCP) is a rare condition characterized by thickening of the dura mater.
- Diagnosis typically relies on neuroimaging, but atypical presentations can pose challenges.
Observation:
- This report details a unique case of HCP with calcification of the tentorium and superior sagittal sinus.
- Magnetic resonance (MR) imaging revealed tentorial thickening and occlusion of major dural sinuses.
Findings:
- Crucially, the fibrocalcific occlusion of dural sinuses exhibited a signal-void appearance on spin-echo MR images.
- This appearance mimicked patent sinuses, a potentially misleading finding for radiologists.
Implications:
- Misinterpretation of these imaging findings could lead to delayed or incorrect diagnosis of HCP.
- Awareness of this imaging artifact is critical for accurate diagnosis and management of hypertrophic cranial pachymeningitis.