Idiopathic hypertrophic cranial pachymeningitis: clinical-radiological-pathological correlation of bone involvement

We present the clinical, radiological, and pathological findings in an elderly man who developed a progressive superior orbital fissure syndrome due to idiopathic hypertrophic cranial pachymeningitis. The unique aspect of this case concerned the increased density of the sphenoid ridge and lateral orbital wall observed by using computed tomography, and the enhancement of the marrow signal seen on magnetic resonance imaging. These neuroimaging abnormalities of bone resulted from an indirect nonspecific response of the marrow to the adjacent soft tissue and dural inflammatory process.