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.
Keywords: Cerebrospinal fluid leak; Differential diagnosis; Epidural blood patch; Granulomatosis with polyangiitis; Hypertrophic pachymeningitis; Orthostatic headache; Spontaneous intracranial hypotension.
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