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Differential Diagnosis of Nervous System Disorders

Diffuse Dural Thickening!!navigator!!

  1. Metastasis: prostate, melanoma, breast, rectum, lymphoma
  2. Meningioma
  3. Granuloma: TB, sarcoid, syphilis
  4. Wegener granulomatosis
  5. Granulomatous angiitis
  6. Erdheim-Chester disease (lipid granulomatosis)
  7. Rheumatoid arthritis
  8. Neuroblastoma
  9. Idiopathic hypertrophic pachymeningitis
  10. Pachymeningitis interna hemorrhagica (breast mets)

Dural Calcifications!!navigator!!

  1. Normal variant (esp. if small)
  2. Chronic renal failure
  3. Tertiary hyperparathyroidism
  4. Ankylosing spondylitis
  5. Arachnoiditis ossificans
    Frequently associated with:
    • significant often progressive neurologic deficit, trauma, surgery, subarachnoid hemorrhage, myelography (with oil-based contrast agents)

Mass Lesion of Dura!!navigator!!

  1. Meningioma
  2. Hemangiopericytoma
  3. Primary dural lymphoma
  4. Metastasis: breast. lung, prostate
  5. Rosai-Dorfman disease
  6. Solitary fibrous tumor
  7. EBV-associated leiomyoma and leiomyosarcoma
  8. Melanocytic lesion: primary / metastatic
  9. Melanocytoma
  10. Erdheim-Chester disease
  11. Sarcoid

Leiomyoma and leiomyosarcoma should be included in the DDx of dural-based masses in AIDS patients.

Dural Tail Sign!!navigator!!

= curvilinear area of enhancement tapering off from the margin of the lesion along dural surface ← dural tumor infiltration / reactive inflammatory hypervascularity

  1. Meningioma
  2. Acoustic schwannoma
    Other superficial masses
  3. Chloroma
  4. Primary CNS lymphoma
  5. Sarcoidosis
  6. Syphilitic gumma
  7. Metastasis

Leptomeningeal Disease!!navigator!!

  1. INFLAMMATION
    1. Langerhans cell histiocytosis
    2. Sarcoidosis
    3. Wegener granulomatosis
    4. Chemical meningitis: rupture of epidermoid
  2. INFECTION
    1. Bacterial meningitis
    2. Tuberculous meningitis
    3. Fungal meningitis
    4. Neurosyphilis
  3. TUMOR
    1. Primary meningeal tumor
      1. Meningioma
      2. Glioma: primary leptomeningeal glioblastomatosis / gliosarcomatosis
      3. Melanoma / melanocytoma
      4. Sarcoma
      5. Lymphoma
    2. CSF-spread from primary CNS tumor
      1. Medulloblastoma
      2. Germinoma
      3. Pineoblastoma
    3. Metastasis
      1. Breast carcinoma
      2. Lymphoma / leukemia
      3. Lung carcinoma
      4. Malignant melanoma
      5. Gastrointestinal carcinoma
      6. Genitourinary carcinoma
  4. TRAUMA
    1. Old subarachnoid hemorrhage
    2. Surgical scarring from craniotomy
    3. Lumbar puncture

Outline