Involvement of the brain and meninges is rare in Wegener's granulomatosis (
WG); it has been reported in 1.2-8 % of patients. Meningeal involvement in
WG has been reported in imaging as being confined to the duramater, and is
thought to represent granulomatous infiltration. We present a case of WG wi
th abnormal pial enhancement and involvement of the perivascular spaces on
MRI, pathologically proven to represent granulomatous infiltration due to t
he primary disease rather than to infection.