Diagnostic Challenges in Intracranial Rosai-Dorfman Disease: Differentiating It From Meningiomas Using Imaging

Rosai-Dorfman disease (RDD) is a rare non-Langerhans cell histiocytosis (non-LCH) with intracranial involvement being exceptionally uncommon. We report a 45-year-old woman presenting with neurological symptoms initially suggestive of a stroke, later found to have a dural-based lesion resembling a meningioma. MRI revealed a mixed T1 isointense to hyperintense and T2 hyperintense mass with restricted diffusion on diffusion-weighted imaging (DWI) and lower apparent diffusion coefficient (ADC) values, findings atypical for meningiomas. Intracranial RDD commonly mimics meningiomas radiographically but can be distinguished by unique imaging features. Surgical resection remains the treatment of choice for isolated lesions, though recurrence is possible. This case highlights the importance of recognizing RDD in the differential diagnosis of dural-based lesions to ensure accurate diagnosis and tailored management.