J Neurol Neurosurg Psychiatry 84:354-355 doi:10.1136/jnnp-2012-303295
  • Neurological pictures

Idiopathic hypertrophic cranial pachymeningitis: a rare but treatable cause of headache and facial pain

  1. Christian Enzinger1,2
  1. 1Department of Neurology, Medical University of Graz, Graz, Austria
  2. 2Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria
  1. Correspondence to Dr Michael Khalil, Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, A-8036 Graz, Austria; michael.khalil{at}
  1. Contributors MK collected the data and drafted the manuscript. FE and FF revised the manuscript. CE collected the data and revised the manuscript.

  • Received 23 May 2012
  • Revised 30 July 2012
  • Accepted 31 July 2012
  • Published Online First 8 September 2012


Idiopathic Hypertrophic Cranial Pachymeningitis (IHCP) is a rare disease with pain and compression related cranial nerve dysfunction as main clinical features. The leading diagnostic finding of IHCP consists of diffuse or localised thickening of the dura, which demands appropriate imaging and image interpretation. This case description aims at increasing the awareness for the clinical symptoms and imaging findings of this rare disease to allow prompt diagnosis and treatment initiation.

Case description

An 82-year-old man presented with recurrent left sided headache and worsening facial pain, which had begun more than 1 year ago. Neurological examination at presentation revealed ptosis of the left eye and gaze-induced nystagmus when looking to the left; visual function was intact and no other neurological signs or symptoms were noted. Pre-existing medical conditions included atrial arrhythmia requiring treatment with oral anticoagulants and arterial hypertension. External brain MRI at …

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