Headache and Dural Enhancement: Two Case Studies of Different Treatable Pathologies

Hypertrophic pachymeningitis (HP) and spontaneous intracranial hypotension are different treatable diseases, which should promptly be recognized and treated to prevent neurologic sequelae. Headache and dural enhancement are the main features of both diseases, thus differentiating between these 2 con...

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Bibliographic Details
Published in:World neurosurgery 2020-09, Vol.141, p.306-310
Main Authors: Pensato, Umberto, Benini, Matteo, Fabbri, Viscardo Paolo, Avoni, Patrizia, Foschini, Maria Pia, Rizzo, Giovanni, Liguori, Rocco
Format: Article
Language:English
Subjects:
Aged
Blood Patch, Epidural - methods
Brain - pathology
Cerebrospinal fluid leak
Differential diagnosis
Epidural blood patch
Female
Granulomatosis with polyangiitis
Headache - diagnosis
Headache - etiology
Headache - pathology
Humans
Hypertrophic pachymeningitis
Hypertrophy - complications
Hypertrophy - pathology
Intracranial Hypotension - diagnosis
Intracranial Hypotension - etiology
Intracranial Hypotension - pathology
Magnetic Resonance Imaging - adverse effects
Male
Meningitis - complications
Meningitis - pathology
Middle Aged
Orthostatic headache
Spontaneous intracranial hypotension
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Summary:Hypertrophic pachymeningitis (HP) and spontaneous intracranial hypotension are different treatable diseases, which should promptly be recognized and treated to prevent neurologic sequelae. Headache and dural enhancement are the main features of both diseases, thus differentiating between these 2 conditions can be difficult. We present 2 cases with headache and dural enhancement, in which the differential diagnosis was challenging at presentation because, in both cases, clear positional pain modification was not reported. Each patient was referred to us with the suspicion of a diagnosis actually affecting the other one. Based on further findings, which supported diagnosis of spontaneous intracranial hypotension in the first case and of HP in the second one, we briefly review clinical, radiologic, and laboratory features, which can help in the differential diagnosis. An accurate diagnostic workup is mandatory to distinguish among HP and intracranial hypotension.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2020.06.126