Background and purpose: Pachymeningitis cranialis hypertrophica is a heterogeneous disorder with many different causes. We correlate clinical characteristics, CT or MRI scans with angiography or magnetic resonance venography (MRV) in three patients in whom the etiology was undetermined. Case descriptions: All three patients had neurologic deficits and abnormalities in the venous phase of angiography, in particular, findings consistent with venous sinus compromise. Conclusion: This finding draws attention to the possible effect of pachymeningitis in producing venous congestion, which may be related in some cases to the clinical manifestations of the disorder.