A 27-year-old gentleman, presented with 3 months history of blurring of vision associated with headache. There was no history of loss of consciousness, seizures, or weakness in limbs. Visual examination showed acuity of 6/6 bilaterally with left temporal field defect.\nMRI of brain, T1W, T2 axial, contrast and multiplanar sequences were performed which showed evidence of lobulated mixed signal intensity lesion seen in the optic chiasm, measuring 18 × 11 mm. Multiple hemorrhagic foci of varying sizes were seen within the lesion. No obvious enhancement was seen after IV contrast material injection. On the right side, the lesion was extending anteriorly up to the optic canal and superiorly abutting the hypothalamus. The features were suggestive of CM of the optic chiasm [Figures and ].\nThe lesion was removed neuro-endoscopically through the trans-nasal trans-sphenoidal route. After reaching the sella, dura opened and the pituitary gland was displaced. Under-surface of chiasm was visualized. The lesion was seen on the surface with brownish discoloration. A small incision was made and the lesion could be removed. Post–operatively, there was a transient worsening left temporal field defect. The histopathological examination and features are consistent with organizing hematoma.
A 16-year-old boy presented progressive visual disturbance that started 5 months prior with headache. The headache had subsided; however, the visual symptoms persisted. His visual acuity was 0.02 in his left eye and 0.3 in his right eye. The Goldmann perimetry field test revealed a large central scotoma of his left eye field and a temporal hemianopsia of his right eye field (). Brain MR imaging showed a heterogeneous hemorrhagic mass in the optic chiasm, extending posteriorly along the bilateral optic tracts with no definitive contrast enhancement (). The presumptive diagnosis was an unusual CM involving the optic pathway. Following left pterional craniotomy and sylvian dissection, the optic chiasm, which was mottled with dark dots, was visualized. A small window was made on the lateral side of the optic chiasm. Chocolate-colored tissue mixed with old blood was partially evacuated (). The pathology report confirmed the diagnosis of CM. Following surgery, the patient's visual acuity in his left eye slightly improved (0.03/0.3). The central scotoma of his left eye field had resolved; however, he subsequently acquired a nasal hemianopsia in his left eye field. At the patient's 2-year follow-up, there were no episodes of headache, visual change, or documented bleeding on serial MR imaging ().