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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.

Homonymous visual field defects are rare in patients with MS and are usually caused by large lesions in the white matter of the posterior optic radiations and visual cortex. The postulate of Holmes and others, early this century, that optic radiation lesions could produce quad-rantic defects has recently been questioned. We report the full recovery of a patient with probable MS who presented with congruous quadrantanopia from a small white matter lesion in the contralateral trigone area.

We describe a 34-year-old man with a 17-year history of multifocal fibrosclerosis resulting in unique neurologic complications. Episcleritis, orbital pseudotumor, and sclerosing cholangitis accompanied a florid intracranial inflammatory pachymeningitis. The latter was associated with blindness, multiple cranial neuropathies, pseudotumor cerebri, and seizures. Extensive investigation failed to reveal an etiology. Corticosteroids were ineffective in preventing progression of the disorder, and the value of antineoplastic therapy was uncertain. Multifocal fibrosclerosis, a rare disorder, may result in a confusing array of neurologic manifestations.

Seven patients, each with a different pattern of homonymous visual loss caused by ischemic infarction of the occipital lobe, were studied with computed tomography. The retinotopic representation of the visual field on the occipital lobes, as determined by these studies, fully confirms those deduced by previous investigators.

We studied 11 patients with the uncommon finding of traumatic chiasmal syndrome after closed head trauma. Visual field defects varied from complete monocular blindness and contralateral temporal hemianopia to subtle bitemporal arcuate scotomas. The degree of visual loss was not necessarily related to the severity of the craniocerebral trauma. Diabetes insipidus was present in half of these patients, but unlike the visual abnormalities, this complication was transient.