[Three cases of optic neuropathy associated with hypertrophic pachymeningitis].

ABSTRACT

PURPOSE: We report 3 cases of patients with hypertrophic pachymeningitis associated with perinuclear anti-neutrophil cytoplasmic antibody and IgG 4-positive plasma cell infiltration. CASES The patients' ages ranged from 61 to 76. Two were women and 2 cases involved one eye only. Initial visual acuity of the 4 eyes were counting fingers to 0.3. Decreasing of critical flicker frequency and moderate headache were observed in all cases. Definite diagnosis of hypertrophic pachymeningitis was made by enhanced MRI (magnetic resonance imaging) using Gadolinium. After systemic administration of methylprednisolone, all patients showed improvement in their visual acuity from 0.8 to 2.0 and had no recurrence. CONCLUSIONS: Hypertrophic pachymeningitis is common in elderly patients. It is highly associated with headaches accompanied by symptoms and signs of ischemic optic neuropathy and retrobulbar optic neuritis. Enhanced MRI is helpful in making a definite diagnosis.