VISUAL-LOSS FROM IDIOPATHIC INTRACRANIAL PACHYMENINGITIS

We report three patients with chronic headaches and optic neuropathy d ue to widespread meningeal thickening shown on enhanced MRI; all had b iopsy-proven intracranial pachymeningitis (fibrosclerosis of the menin ges). Two patients had bilateral optic neuropathy, elevated CSF protei n, and polyclonal serum hypergammaglobulinemia. They developed tempora l lobe cortical necrosis or sagittal sinus thrombosis, presumably due to compromised dural venous drainage from extensive meningeal fibrosis . The other patient had multiple cranial nerve palsies and unilateral optic neuropathy with normal CSF. Corticosteroid therapy improved visu al function in all three patients, although all had persisting visual deficits. Gadolinium-enhanced MRI was essential in identifying meninge al inflammation and locating suitable biopsy sites.