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Pineal Apoplexy: Is it a Facilitator for the Development of Pineal Cysts?

  • P.D. McNeely (a1), W.J. Howes (a1) and V. Mehta (a2)
Abstract
Background:

The radiographic identification of pineal cysts has increased dramatically within the last two decades due to the advent of magnetic resonance imaging. Pineal cysts are often found incidentally with only a minority of these lesions ever becoming symptomatic and requiring treatment. Many theories attempting to explain the pathogenesis of these cysts exist.

Methods:

We describe a case of a 12-year-old girl who presents with a pineal hemorrhage of unknown etiology with associated hydrocephalus.

Results:

Her hydrocephalus was initially treated with an external ventricular drain followed by a third ventriculostomy. She had no evidence of elevated beta human chorionic gonadotropin or alpha-fetoprotein within the serum or cerebrospinal fluid. Follow-up imaging at seven weeks revealed resolution of her hemorrhage, however, there was development of a progressive cystic lesion within the pineal region. In order to make a definitive tissue diagnosis, a supracerebellar infratentorial surgical approach with complete resection was performed. During the resection, brownish fluid was aspirated from the cyst and the cyst wall was removed. The pathological diagnosis was a pineal cyst.

Conclusions:

Although cases have been described of pineal apoplexy with an underlying cyst, this case describes the development of a progressive pineal cyst secondary to a hemorrhage. This case demonstrates that pineal hemorrhage may be a promotor for the development or progression of pineal cysts.

RÉSUMÉ: Contexte:

L’identification radiologique de kystes pinéaux a augmenté de façon dramatique dans les deux dernières décennies grâce à la disponibilité de l’imagerie par résonance magnétique. Les kystes pinéaux sont souvent une découverte fortuite. Cependant, seulement une minorité de ces lésions devient symptomatique et nécessite un traitement. Plusieurs théories tentent d’expliquer la pathogenèse de ces kystes.

Méthodes:

Nous décrivons le cas d’une jeune fille de 12 ans qui a consulté pour une hémorragie de la glande pinéale d’étiologie inconnue associée à une hydrocéphalie.

Résultats:

Son hydrocéphalie a été traitée initialement au moyen d’un drain ventriculaire, puis par une ventriculostomie du troisième ventricule. Elle ne présentait pas d’élévation de la bêta-gonadotropine chorionique humaine ou de l’alpha-foetoprotéine dans le sérum ou le liquide céphalo-rachidien. L’imagerie en série sur une période de sept semaines a montré la résorption de l’hémorragie accompagnée cependant du développement d’une lésion kystique progressive dans la région de la pinéale. Afin d’établir un diagnostic tissulaire définitif, une resection complète a été effectuée par une approche chirurgicale sous-tentorielle. Pendant la résection, un liquide brunâtre a été aspiré du kyste et la paroi du kyste a été enlevée. Le diagnostic anatomopathologique a été celui de kyste pinéal.

Conclusions:

Bien que des cas d’apoplexie de la glande pinéale avec kyste sous-jacent aient été décrits, ce cas illustre le développement progressif d’un kyste secondaire à une hémorragie. Ce cas démontre que l’hémorragie de la pinéale peut promouvoir le développement ou la progression de kystes de la glande pinéale.

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References
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Canadian Journal of Neurological Sciences
  • ISSN: 0317-1671
  • EISSN: 2057-0155
  • URL: /core/journals/canadian-journal-of-neurological-sciences
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