An Autopsy Case of Sudden Unexpected Death Due to a Glial Cyst of the Pineal Gland

Na, Joo Young; Lee, Kyung‐Hwa; Kim, Hyung-Seok; Park, Jong-Tae

doi:10.1097/paf.0000000000000107

Cited by 10 publications

(12 citation statements)

References 6 publications

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“…Untreated, the potential exists for catastrophic obstructive hydrocephalus, although evidence from case reports remains suggestive rather than definitive. 15-17…”

Section: Discussionmentioning

confidence: 99%

Defining Occult High-Risk Cysts of the Pineal Region: A Case Series

Guadix

Marianayagam

Weidman

et al. 2023

Operative Neurosurgery

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BACKGROUND: Absence of hydrocephalus on neuroimaging may impart a false sense of security for patients with pineal cysts. In this case series, we characterize a subset of patients with pineal cysts having an occult presentation. Unifying features of worsening paroxysmal headaches suggesting intermittent obstructive hydrocephalus and radiographic evidence of third ventricular invagination characterize these patients as high risk. OBJECTIVE: To define features of occult, high-risk pineal cysts and outcomes of endoscopic cyst fenestration. METHODS: Charts were retrospectively reviewed for patients with pineal cysts evaluated at our institution between 2018 and 2021 who underwent endoscopic cyst fenestration. To capture cysts presenting as occult, patients were excluded if hydrocephalus was noted at presentation. Relevant clinical history, imaging, operative data, and clinical outcomes were reviewed. RESULTS: Of 50 pineal cyst patients, 4 satisfied inclusion criteria. All patients presented with worsening paroxysmal headaches. In addition, 75% (3/4) also experienced intermittent syncope. Patients exhibited no hydrocephalus (n = 3) or fluctuating ventricular size on longitudinal imaging (n = 1). In all cases, high-resolution sagittal 3-dimensional T2 magnetic resonance imaging demonstrated invagination of the cyst anteriorly into the posterior third ventricle. All patients underwent endoscopic cyst fenestration with complete symptom resolution (mean follow-up of 20.6 months; range 3.5-37.4 months). CONCLUSION: The clinical history for occult, high-risk pineal cysts is notable for worsening paroxysmal headaches and episodic alterations of consciousness suggesting intermittent obstructive hydrocephalus. Because ventricular size can appear normal on standard imaging protocols, clinical suspicion should trigger workup with high-resolution magnetic resonance imaging designed to detect these cysts. Endoscopic cyst fenestration is a safe and efficacious management strategy.

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“…Untreated, the potential exists for catastrophic obstructive hydrocephalus, although evidence from case reports remains suggestive rather than definitive. 15-17…”

Section: Discussionmentioning

confidence: 99%

Defining Occult High-Risk Cysts of the Pineal Region: A Case Series

Guadix

Marianayagam

Weidman

et al. 2023

Operative Neurosurgery

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“…Central nervous system benign tumors other than CPP can cause fatality (Barranco et al 2018). Despite the rarity of these cases, Milroy and Smith (1996) and Na et al (2014) reported several cases where pineal gland cysts, which are benign tumors, caused compression and sudden unexpected deaths. Although in these reports a contributing factor such as an intense effort was responsible for an increase in intracranial pressure and cerebral perfusion and thus death, in our case, we do not know exactly if the deceased had an intense physical effort or any other contributing factor before his death.…”

Section: Discussionmentioning

confidence: 99%

An unexpected sudden death due to a choroid plexus papilloma: an autopsy case report

Zaara

Gharsallaoui

Abdessayed

et al. 2021

Egypt J Forensic Sci

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Background Choroid plexus papillomas (CPPs) are histopathologically benign and rare central nervous system tumors. These tumors remain more frequent in children than adults. It is infrequent for these tumors to cause a sudden unexpected death. We aim in this case to discuss the unusual and fatal presentation of choroid plexus papilloma and the mechanism of death. Case presentation we report the case of a 61-year-old man with no medical history, diagnosed at autopsy with a previously unknown CPP. Initial complaints were chronic headache occurring in the last month and acute chest pain for two days. The forensic autopsy including the histopathologic examination showed a tumoral mass of the choroid plexus in the fourth ventricle diagnosed as a psammomatous CPP. The cause of death in this case was attributed to a massive cerebral edema caused by the tumoral mass. Conclusions Through this case report, we stress the importance of an early and a vigorous investigation of every headache and an early detection of this tumor and we highlight as well the role of the post mortem examination to detect such a fatal complication.

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“…Сужение венозных сосудов может вызывать нарастающее давление в венах и, как следствие, интерстициальный отек мозгового вещества [54]. По данным других исследований [9,11,13], причина головной боли заключается в закрытии кистой входа в водопровод мозга, как это бывает при коллоидных кистах, либо кровоизлиянии в КШТ.…”

Section: головная больunclassified

“…Почти у половины (44%) пациентов, оперированных по поводу КШТ, имелась гидроцефалия, которая в 33% случаев была вызвана кровоизлиянием в кисту. Помимо этого, в литературе описаны случаи синкопальных состояний и случаи внезапной смерти, связанные с внезапным закрытием кистой входа в сильвиев водопровод [8,9,[11][12][13].…”

Section: гидроцефалия и внутричерепная гипертензияunclassified