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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 27:2217-2220, November-December 2006
© 2006 American Society of Neuroradiology

Case Report
HEAD & NECK

Inflammatory Myofibroblastic Tumor of the Orbit with Associated Enhancement of the Meninges and Multiple Cranial Nerves

A.M. McKinney^a, J. Short^a, L. Lucato^a, K. SantaCruz^a, Z. McKinney^a and Y. Kim^a

^a From the Department of Radiology, University of Minnesota Medical School & Hennepin County Medical Center, Minneapolis, Minn

Address correspondence to Alexander McKinney, MD, Hennepin County Medical Center, Department of Radiology, 701 Park Ave. South, Minneapolis, MN 55415; e-mail: mckin022{at}umn.edu

SUMMARY: Inflammatory myofibroblastic tumor (IMT), Tolosa-Hunt syndrome (THS), and idiopathic hypertrophic pachymeningitis (IHP) seem to be part of a spectrum of disorders that have diverse locations but similar histologic and imaging findings. We report a case of a 50-year-old man presenting with multiple progressive cranial nerves palsies with leptomeningeal cranial nerve enhancement on MRI (II, V1–V3, and X), orbital and infraorbital masses, prominence within the left cavernous sinus, and diffuse dural enhancement. Biopsies of the orbital lesion and infraorbital nerve revealed IMT. The patient’s lesions, symptoms, and dural enhancement quickly improved with steroid administration and nearly resolved over multiple subsequent scans over the next few months. This case illustrates a rare case of pseudotumor mimicking a more aggressive appearance that would usually portend a case of malignancy. There is a potential association of IMT, THS, and IHP, which may have existed in a concomitant fashion in this patient. The case also describes the unique finding of enhancement of the cisternal segments of multiple cranial nerves (simulating leptomeningeal malignant involvement), which may be related to inflammatory perineural edema or ischemic neuropathy.

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