Martin N, Masson C, Henin D, Mompoint D, Marsault C, Nahum H
Department of Radiology, Hopital Beaujon, Clichy, France.
AJNR Am J Neuroradiol. 1989 May-Jun;10(3):477-84.
Three patients with diffuse idiopathic cranial pachymeningitis with predominant involvement of the tentorium and falx are reported. Progressively increasing headaches were the usual symptoms, along with ataxia and various cranial nerve palsies. CT in all cases and MR imaging in two cases detected isolated thickened dura mater. In one case, MR depicted dural involvement as a very large, hypointense area with fine hyperintense edges on T2-weighted images. Microscopic examination of thickened dura revealed extensive fibrotic tissue with a chronic inflammatory infiltrate containing lymphocytes, plasma cells, and scattered eosinophils; these findings closely paralleled the MR features. Only four cases with similar pathologies have been described, all before the advent of CT and MR. We discuss the different causes of thickened dura mater as well as the significance of the fact that dural thickening can be responsible for occlusion of the dural sinuses. Cranial pachymeningitis is a rarely reported disease that can resemble other disorders associated with tentorial thickening; CT and MR can help differentiate it from these other disorders.
本文报告了3例以小脑幕和大脑镰受累为主的弥漫性特发性硬脑膜炎患者。逐渐加重的头痛是常见症状，同时伴有共济失调和各种颅神经麻痹。所有病例均行CT检查，2例还进行了磁共振成像（MR）检查，均发现硬脑膜孤立性增厚。其中1例患者的MR检查显示，在T2加权图像上，硬脑膜受累表现为一个非常大的低信号区，边缘有细小的高信号。对增厚硬脑膜进行显微镜检查发现，有广泛的纤维化组织，伴有慢性炎性浸润，浸润细胞包括淋巴细胞、浆细胞和散在的嗜酸性粒细胞；这些发现与MR特征密切相符。之前仅描述过4例具有类似病理表现的病例，均在CT和MR出现之前。我们讨论了硬脑膜增厚的不同原因，以及硬脑膜增厚可导致硬脑膜窦闭塞这一事实的意义。硬脑膜炎是一种罕见的疾病，可类似于其他与小脑幕增厚相关的疾病；CT和MR有助于将其与其他疾病区分开来。
