From the Guidelines
Dural calcification is an active process of ossification that requires careful monitoring and potentially surgical intervention if symptomatic, as indicated by the K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients 1. Dural calcification refers to the abnormal deposition of calcium in the dura mater, the outermost layer of the meninges that surrounds the brain and spinal cord. This condition is typically an incidental finding on imaging studies and is often asymptomatic. The most common causes include:
- Aging
- Chronic inflammation
- Previous trauma
- Infections like tuberculosis
- Metabolic disorders such as hyperparathyroidism
- Certain genetic conditions No specific treatment is generally required for asymptomatic dural calcifications. However, if the calcification is causing symptoms such as headaches or neurological deficits due to compression of neural structures, surgical intervention may be considered to remove the calcified tissue. The decision for treatment should be based on the patient's symptoms, the location and extent of calcification, and underlying causes, as calcification is an active process of ossification 1. Calcium deposits in the dura mater form when calcium salts precipitate in areas of tissue damage or inflammation, often as part of a healing process. Regular follow-up imaging may be recommended to monitor asymptomatic calcifications for any changes or progression that might eventually require intervention.
From the Research
Dural Calcification
- Dural calcification refers to the accumulation of calcium deposits in the dura mater, a protective layer of tissue surrounding the brain and spinal cord 2.
- This condition can occur in various forms, including calcification and ossification of the convexity of the falx cerebri, a fold of dura mater in the brain 2.
- Dural calcification can be associated with neighboring brain tissue and blood vessel involvement, and may be related to conditions such as hyperparathyroidism, vitamin D-intoxication, or chronic renal failure 2.
Chronic Calcified Subdural Hematoma
- Chronic calcified subdural hematoma is a rare condition, estimated to represent 0.3-2.7% of chronic subdural hematomas 3, 4.
- This condition is characterized by the presence of a calcified inner membrane in a subdural collection, which can be diagnosed using computed tomography (CT) scans and magnetic resonance imaging (MRI) 3, 4.
- Surgical treatment is often necessary for symptomatic cases, and can result in significant improvement of the patient's symptoms 3, 4.
Diagnosis and Differential Diagnosis
- CT scans and MRI are essential tools for diagnosing chronic subdural hematomas, including calcified cases 3, 4, 5, 6.
- Differential diagnosis between chronic subdural hematoma and meningeal fibrosis is crucial, as the latter may mimic the former on unenhanced CT and MR scans 5.
- Enhanced CT or MR scans can help differentiate between these conditions, and histologic examination of biopsies may be necessary to confirm the diagnosis 5.