Prominent hyperintense areas in swollen optic pathway: An indicator of congestive glymphatic pathway?

A 34-year-old woman presented with progressive visual impairment for 2 months. Computed tomography and magnetic resonance imaging (MRI) revealed a suprasellar cyst. The patient underwent endoscopic endonasal surgery, which resulted in gross total resection with a diagnosis of craniopharyngioma. Postoperatively, the patient's visual function improved. The constructive interference steady-state (CISS) sequence revealed a remarkable resolution of hyperintense areas in the swollen optic nerve and tract. A 36-year-old woman sustained an abrupt visual loss. She had been diagnosed with cavernous malformations (CMs) in the right frontal lobe and suprasellar region 11 years ago, with an intact optic tract. Cerebral MRI at presentation revealed marked enlargement of the suprasellar CM and swelling of the right optic tract, accompanied by predominant hyperintense areas in the optic pathway. The patient's visual function showed significant improvement with conservative management. The CISS sequence performed 3 months later showed remarkable resolution of hyperintensity in the optic pathway. Prominent hyperintense areas in the optic pathway may indicate congestion of glymphatic flow. Reduction in such areas may be a radiological biomarker reflecting the improvement of visual impairment.