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Neurosurgical Review
Published in: Neurosurgical Review 4/2015

01-10-2015 | Review

Pachymeningeal enhancement—a comprehensive review of literature

Authors: Joyce Antony, Craig Hacking, Rosalind L. Jeffree

Published in: Neurosurgical Review | Issue 4/2015

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Abstract

Pachymeningeal enhancement, synonymous with dural enhancement, is a radiological feature best appreciated on a contrast-enhanced magnetic resonance imaging (MRI). The vasculature of the dura mater is permeable, facilitating avid uptake of contrast agent and subsequent enhancement. Thin, discontinuous enhancement can be normal, seen in half the normal population. In patients complaining of postural headaches worse on sitting, gadolinium-enhanced MRI findings of diffuse pachymeningeal enhancement is highly suggestive of benign intracranial hypotension. In these cases, the process of pachymeningeal enhancement is explained by the Monro–Kellie doctrine as compensatory volume changes by vasocongestion and interstitial oedema of the dura mater due to decreased cerebrospinal fluid (CSF) pressure. Focal and diffuse pachymeningeal enhancement can also be attributed to infectious or inflammatory, neoplastic and iatrogenic aetiologies. Correction of the underlying pathology often results in spontaneous resolution of the pachymeningeal enhancement. There have also been reports of pachymeningeal enhancement associated with cerebral venous sinus thrombosis, temporal arteritis, baroreceptor reflex failure syndrome and arteriovenous fistulae.
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Metadata
Title
Pachymeningeal enhancement—a comprehensive review of literature
Authors
Joyce Antony
Craig Hacking
Rosalind L. Jeffree
Publication date
01-10-2015
Publisher
Springer Berlin Heidelberg
Published in
Neurosurgical Review / Issue 4/2015
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI
https://doi.org/10.1007/s10143-015-0646-y

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