Clinical and magnetic resonance imaging analysis of 13 patients with hypertrophic cranial pachymeningitis

Objective To investigate clinical presentations, laboratory examinations, magnetic resonance imaging (MRI) appearances and treatment of hypertrophic cranial pachymeningitis (HCP). Methods The clinical data of 13 patients with HCP receiving comprehensive therapy in Huashan Hospital from January 2007 to January 2013 were analyzed retrospectively． Results The onset of HCP was mostly chronic with an average duration of 26.7 months. The main clinical manifestations of the 13 patients were chronic headaches (12/13) and cranial nerve paralysis (12/13). Inflammation markers and cerebro-spinal fluid (CSF) protein levels increased in patients with HCP and gradually became normal after the treatment. The MRI demonstrated local or diffused thickened dura located in tentorium (10/13), falx cerebrum (5/13), frontal lobe (4/13), temporal lobe (7/13) and parietal lobe (4/13). The signal intensity was isointense on T1-weighted MR images and hypointense on T2-weighted MR images. Enhanced MR images showed conspicuous enhancement of the dural edges. Corticosteroid therapy improved the clinical symptoms in 12 of 13 patients. Conclusions HCP typically causes headache and paralysis of multiple cranial nerves. Enhanced MRI shows characteristic manifestations. At present corticosteroid therapy is the treatment of choice followed by immunosuppressive agent and radiotherapy. Key words: Meningitis; Dura mater; Hypertrophy; Magnetic resonance imaging