SHM Converge Scientific Abstract ePoster Gallery-Diffuse Pachymeningeal Enhancement

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This case describes an 83-year-old woman who presented with a 3-hour episode of word-finding difficulty and right-sided weakness, consistent with a transient ischemic attack (TIA). Her history included rheumatoid arthritis on chronic steroids and hypertension. Initial CT, CTA, and CT perfusion were unremarkable, and non-contrast MRI showed no acute infarct but did reveal extensive dural thickening. Contrast-enhanced MRI demonstrated smooth, thick, diffuse supra- and infratentorial pachymeningeal enhancement (PME) extending through the foramen magnum.<br /><br />The differential diagnosis for diffuse PME includes spontaneous intracranial hypotension, autoimmune disease such as rheumatoid meningitis, infection, neoplasm, and other inflammatory disorders. In this patient, several causes were considered unlikely: she had no headache or postural symptoms to suggest spontaneous intracranial hypotension; no infectious symptoms; no clinical rheumatoid arthritis flare; and lumbar puncture, including cultures, cytology, ACE, VDRL, IgG4, and flow cytometry, was normal. Importantly, her neurological deficits improved spontaneously without antimicrobial therapy, and repeat MRI at 3 months showed complete resolution of the dural enhancement.<br /><br />The authors note that diffuse PME associated with TIA has not previously been reported. They emphasize the diagnostic value of MRI in patients with transient neurological dysfunction, as unusual imaging findings can mimic other serious conditions. The case also highlights that accurate recognition of PME patterns is essential, since misdiagnosis could lead to inappropriate treatment or missed life-threatening disease.

Asset Subtitle

Rafae Shaikh

Meta Tag

Author List Asiya Tafader, Nikola Perosevic, Rafae Shaikh

Category Clinical Vignettes

Concept Pachymeningeal Enhancement

Concept Diffuse Thick Continuous Pachymeningeal Enhancement

Concept Spontaneous Intracranial Hypotension

Concept Transient Ischemic Attack

Concept MRI Contrast Administration

Distinguished Non-Finalist

Presenter Organization University of Connecticut

Presenting Author Rafae Shaikh

Track Adult

Keywords

transient ischemic attack

pachymeningeal enhancement

diffuse dural thickening

rheumatoid arthritis

MRI

intracranial hypotension

word-finding difficulty

right-sided weakness

differential diagnosis

neurological dysfunction

Pachymeningeal Enhancement

Diffuse Thick Continuous Pachymeningeal Enhancement

Spontaneous Intracranial Hypotension

Transient Ischemic Attack

MRI Contrast Administration