Fig. 7.

Pachymeningeal enhancement in idiopathic hypertrophic meningitis (A, B) and Tolosa-Hunt syndrome (C, D) on axial T1 postcontrast images. A patient with painless vision loss shows pachymeningeal enhancement (arrows, A, B) of the right cavernous sinus, consistent with idiopathic hypertrophic meningitis. Another patient with painful ophthalmoplegia, sudden diplopia, and right proptosis (C) demonstrates pachymeningeal enhancement along the right middle cranial fossa and cavernous sinus (arrows, C) and orbital apex (arrow, D) with orbital edema and fat stranding (not shown), consistent with Tolosa-Hunt syndrome.