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We report three patients with chronic headaches and optic neuropathy due to widespread meningeal thickening shown on enhanced MRI;all had biopsy- proven intracranial pachymeningitis(fibrosclerosis of the meninges).Two patients had bilateral optic neuropathy,elevated CSF protein,and polyclonal serum hypergammaglobulinemia.They developed temporal 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 visual function in all three patients,although all had persisting visual deficits. Gadolinium-enhanced MRI was essential in identifying meningeal inflammation and locating suitable biopsy sites. |
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cerebrospinal fluid,abnormal
cranial neuropathy
cranial neuropathy,multiple
dura,thickened
headache
hypertrophic intracranial pachymeningitis
meningeal biopsy
meningeal enhancement
MRI
MRI,abnormal
optic neuropathy
optic neuropathy,bilateral
pachymeningitis,cranial
steroid therapy,CNS treatment and complications with
treatment of neurologic disorder
visual loss
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