Optic nerve compression from a basal encephalocele

A woman developed headaches, transient visual obscurations, anosmia, and decreased visual acuity. Ocular examination showed bilateral pulsatile proptosis and disc edema with choroidal folds. Standardized ophthalmic echography showed absence of bony orbital roofs, prominent dural pulsations, direct apposition of brain parenchyma and orbital tissues, and echographic signs suggesting bilateral optic nerve compression. CT and MRI showed a large defect in the floor of the anterior cranial fossa. The cribriform plate, both orbital roofs, and sphenoid bones were displaced by a large basal encephalocele. Clinical improvement followed reconstruction of the anterior cranial fossa and decompression of both optic nerves.