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|LETTER TO EDITOR
|Year : 2013 | Volume
| Issue : 6 | Page : 667-668
Revisiting Eiffel- at night, in brain…
Lakshmanarao Chittem1, Sridhar Ganti2, Alugolu Rajesh1
1 Department of Neurosurgery, Nizam's Institute of Medical Sciences, Panjagutta, India
2 Department of Neurology, SKS Neuro and Polytrauma Centre, Kacheguda, Hyderabad, India
|Date of Submission||30-Oct-2013|
|Date of Decision||30-Oct-2013|
|Date of Acceptance||05-Dec-2013|
|Date of Web Publication||20-Jan-2014|
Department of Neurosurgery, Nizam's Institute of Medical Sciences, Panjagutta
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Chittem L, Ganti S, Rajesh A. Revisiting Eiffel- at night, in brain…. Neurol India 2013;61:667-8
Pattern recognition in neuroimaging is well-known. These patterns catch the imagination of clinicians and the radiologists alike. One among these patterns is "Eiffel by night" sign classically described for reactivation in idiopathic chronic hypertrophic pachymeningitis. , Involvement of falx and tentorium with hypertrophied dura gives the appearance of the illuminated Eiffel tower by night on contrast enhanced coronal sections of T1 weighted image. We could appreciate this sign in three different pathologies affecting the falx and tentorium.
A 45-year-old female was suffering from recurrent episodes of fever, headache, multiple cranial nerve palsies and nuchal rigidity over a period of 10 years. She underwent diagnostic lumbar puncture many a times which showed mild decrease in sugars, moderately elevated protein. Diagnostic lumbar puncture, auto immune work-up could not reveal any specific etiology. However, she responded very well with steroids every time. Magnetic resonance imaging (MRI), T1-weighted images with gadolinium enhancement were obtained. Coronal images of T1-weighted contrast enhanced images revealed brilliant enhancement of the falx cerebri and tentorium cerebelli resembling Eiffel tower [Figure 1]a. This clinical picture of recurrent chronic meningitis with good response to steroids indicates the diagnostic possibility of chronic idiopathic hypertrophic pachymeningitis.
|Figure 1: (a) Magnetic resonance coronal contrast enhanced T1W image in a patient with idiopathic hypertrophic meningitis showing typical "Eiffel by night" sign (b) magnetic resonance imaging (MRI) of a patient with recurrent tentorial meningioma showing falco tentorial thickening and enhancement resembling Eiffel at night (inset showing the illuminated Eiffel tower by night) (c) patient with cortical sinus venous thrombosis showing Eiffel by night sign on coronal contrast enhanced MRI brain; (d) Magnetic resonance veinogram revealing multiple sinus thrombosis (e) 6 months post treatment the dural enhancement pattern disappeared completely with recanalization of sinuses as shown in MR Venogram (f)|
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MRI of a 35-year-old female with recurrent tentorial meningioma revealed the involvement of the tentorium along with falx with intense contrast enhancement. Coronal sections of T1-weighted contrast enhanced images showed recurrence of tumor with enhancement of involved falx and tentorium suggestive of recurrent en-plaque meningioma resembling the appearance of the Eiffel tower [Figure 1]b.
A 32-year-old female presented with complaints of holocranial headache of 30 days duration, increasing drowsiness for 4 days and multiple episodes of vomiting for 1 day. MRI brain plain and contrast study revealed transverse sinus thrombosis. Coronal T1-weighted contrast images revealed intense enhancement of the tentorium and falx cerebri which resembled the appearance of Eiffel tower at night [Figure 1]c. Magnetic resonance venogram revealed pansinus thrombosis [Figure 1]d. After 4 weeks of treatment anticoagulants she recovered completely which was evident radiologically as disappearance of the Eiffel tower appearance [Figure 1]e and recanalization of superficial and deep venous sinuses [Figure 1]f. It is interesting that this is the first time we are describing a reversible "Eiffel by Night" sign in cortical sinus venous thrombosis adding on to the differential diagnosis of 'Eiffel by Night' sign.
Any condition affecting the dura with more focal involvement at falco-tentorial junction can give rise to this appearance. Infective, inflammatory, auto immune and neoplastic etiology should be considered in differential diagnosis of "Eiffel by night" sign. The pathophysiology regarding involvement of falco tentorial dura in cortical venous thrombosis with radiological appearance of "Eiffel by night" sign still remains elusive. However, reversibility of this sign may help us in assessing the response to the given treatment.
| » References|| |
|1.||Thomas B, Thamburaj K, Kesavadas C. ′Eiffel-by-Night′: A new MR sign demonstrating reactivation in idiopathic hypertrophic pachymeningitis. Neuroradiol J 2007;20:194-5. |
|2.||Riku S, Kato S. Idiopathic hypertrophic pachymeningitis. Neuropathology 2003;23:335-44. |