Peace Sign in Calcified Idiopathic Hypertrophic Pachymeningitis

Abstract

The peace sign (Figure 1a) was originally designed in 1958 by Gerald Holtom for the British nuclear disarmament movement. It derived from the semaphore alphabet “N” and “D” representing ‘nuclear’ and ‘disarmament’. We recently cared for an 81-year-old woman with isolated complex-partial seizures who responded well to a medical treatment with carbamazepine. Coronar cranial computed tomography (CCT) (Figure 1b) showed a marked calcification of the tentorium, the posterior supratentorial falx, and the cerebellar falx mimicking a peace sign. Magnet resonance tomography (MRT) showed on a fluid attenuation inversion recovery (FLAIR) sequence (Figure 1c) a diminished signal consistent with calcification. An MRT five years earlier showed marked contrast enhancement of the tentorium and falx and adjacent dura (Figure 1d) on a T1- weighted image. The large sinus had been open. At this time diagnosis of probable idiopathic hypertrophic pachymeningitis was made as the realized evaluation failed to reveal a cause. A lumbar puncture, however, was not performed. As her clinical signs and symptoms resolved spontaneously no specific therapy was initiated. It is suggested that during time the inflammed dura healed by calcification.