Brain Tumor Res Treat.  2020 Apr;8(1):66-70. 10.14791/btrt.2020.8.e4.

Pineal Cyst Apoplexy: A Rare Complication of Common Entity

• Kim E
• Kwon SM

• KMID: 2500125
• DOI: http://doi.org/10.14791/btrt.2020.8.e4

Abstract

Pineal cysts (PCs) are often encountered as incidental findings in intracranial images. The vast majority of cysts are normally asymptomatic and clinically benign. Bleeding into the cysts, which leads to neurological symptoms and signs, is considered to be quite rare. The authors illustrate a newly identified complication of PC in a 56-year-old woman who characterized by headache of sudden onset and vomiting. MRI disclosed a small hemorrhagic PC without narrowing of the cerebral aqueduct. The patient was managed conservatively without any surgical interventions, and she remained symptom-free over a period of 15-year follow-up. The description of this case adds to the limited literature on the series in which nonsurgical treatments had a role in the care for patients with PC complicated by intracystic hemorrhage.

Keyword

Apoplexy; Pineal cyst; Pineal gland

Figure

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  Fig. 1 CT scans of pineal cyst apoplexy. The ventricle width is normal (A) and the cyst is mildly enhanced at the periphery (B).

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  Fig. 2 MRI for pineal cyst (PC) apoplexy. A: Initial examinations display the PC measuring 11×9×7 mm with incomplete rim enhancement. B: The dorsal midbrain remains intact, and the cerebral aqueduct is patent. C: The sign of hemorrhage is visible on gradient echo sequence image. D, E: MR series taken from lying supine and inclined at 45 degrees depict fluid-blood level within the cyst suggesting intracystic hemorrhage. F: At the 15-year follow-up post-apoplexy, the scan reveals the stable cyst with hemosiderin stains in the pineal body.

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