Hypertrophic pachymeningitis (HP) is a rare entity characterized by inflammation and thickening of the dura mater leading to varied manifestations. The etiology can be broadly classified into primary and secondary causes. We sought to characterize the clinico-radiological spectrum and treatment outcomes in hypertrophic pachymeningitis.

It was a single center, cross-sectional retrospective study conducted at a tertiary care center in northern part of India. A keyword search of “pachymeningitis” was carried out to identify patients diagnosed to have HP admitted during the period of 2015 to 2020. Demographic, clinical, radiological, laboratory data and treatment responses were gathered.

A total of 31 patients were identified out of which 18 were classified to have idiopathic HP.Mean age of onset of symptoms was 40.6±15.7 years. Headache was the most common symptom irrespective of the etiology (27/31, 87%). Majority of patients had multiple cranial nerves palsies (26/31, 83.8%). Oculomotor nerve was the most common nerve involved (21/31, 67.7%). Presence of constitutional symptoms and extra neurological involvement was seen more in secondary HP (0/18 vs 6/13). On imaging, focal thickening of the duramater was seen in 70.9% of the patients. Cavernous sinus and tentorium cerebelli were the most common sites of involvement (22/31, 70.9%; 18/31, 58.1%). Steroids were given in all but one patient. Etiology specific treatment was given in patients with secondary HP. More than half of the patients (58.1%) had complete resolution of symptoms with treatment.