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

Umberto Pensato, Matteo Benini, Viscardo Paolo Fabbri, Patrizia Avoni, Maria Pia Foschini, Giovanni Rizzo, Rocco Liguori

Research output: Contribution to journalArticlepeer-review

Abstract

Background: 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. Cases Description: 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. Conclusions: An accurate diagnostic workup is mandatory to distinguish among HP and intracranial hypotension.

Original languageEnglish
Pages (from-to)306-310
Number of pages5
JournalWorld Neurosurgery
Volume141
DOIs
Publication statusPublished - Sep 2020

Keywords

  • Cerebrospinal fluid leak
  • Differential diagnosis
  • Epidural blood patch
  • Granulomatosis with polyangiitis
  • Hypertrophic pachymeningitis
  • Orthostatic headache
  • Spontaneous intracranial hypotension

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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