Vanishing pineal mass in a young patient without therapy: Case report and review of the literature

Patriarca, Lucia; D’Orazio, Federico; Cesare, Ernesto Di; Splendiani, Alessandra

doi:10.1177/1971400916655480

Cited by 4 publications

(2 citation statements)

References 18 publications

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“…36 Some authors attributed cases of spontaneous regression of pineal lesions to ischemic pineal apoplexy. [37][38][39] A precipitating event that leads to bleeding is unknown in most cases. Possible causes (e.g., anticoagulation medication, shunt placement, and pregnancy) are discussed in the following sections.…”

Section: Discussionmentioning

confidence: 99%

Pineal Apoplexy: A Case Series and Review of the Literature

Májovský

Netuka

Lipina

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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Background Pineal apoplexy is a rare condition, with unknown incidence and clinical significance. To elucidate this clinical condition, we analyzed our own case series and performed a review of the literature. Methods We enrolled all patients with a hemorrhagic pineal apoplexy who were referred to our department between January 2000 and January 2020. Hemorrhagic pineal apoplexy was defined as the presence of fluid–fluid levels inside the pineal cyst (PC) on an axial or sagittal magnetic resonance scan. In one patient, after PC apoplexy, we performed a circadian melatonin sampling from peripheral blood to determine the function of the pineal gland. The PubMed database was searched for publications using the terms “pineal” and “apoplexy.” Results Eight patients were enrolled, of which three patients underwent surgical treatment and five patients were managed conservatively. One patient was tested for circadian melatonin secretion. Results confirmed melatonin secretion with preserved physiologic circadian rhythm.Our search of the literature led us to 31 studies that comprised 30 patients with apoplectic PC, 9 with apoplectic pineal tumor, and 1 with bleeding into the normal pineal gland. Most patients presented with headache, nausea, and vomiting, less frequently with acute hydrocephalus and gaze palsy. Twenty patients with a PC underwent resection or aspiration. Two patients underwent shunt placement as the only procedure and five received both shunt and surgical removal. Six patients with a PC were observed without surgical treatment. All the nine patients with a pineal tumor were operated on. In indicated cases, four patients received radiation therapy and one received chemotherapy. Conclusion Clinical significance of hemorrhagic pineal apoplexy ranges from an asymptomatic course to rapid deterioration and death. In patients with mild symptoms, observation is indicated, whereas surgical treatment is reserved for severe cases presenting with obstructive hydrocephalus and includes cerebrospinal fluid diversion, resection of apoplectic pineal lesions, or both.

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Section: Discussionmentioning

confidence: 99%

Pineal Apoplexy: A Case Series and Review of the Literature

Májovský

Netuka

Lipina

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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“…Indeed, large tumors may compress or outgrow the feeding vessels, especially those coming from the lateral pineal artery, which often provides unilateral vascularization to the pineal gland. An ischemic mechanism can be hypothesized when neuroimaging exams do not show signs of hemorrhage, as happened in a case of a vanishing pineal gland in a girl after acute onset of headaches, vomiting, dizziness, and tinnitus described by Patriarca et al (73). In these cases, MRI is the modality of choice for follow-up examinations (74) (Figure 2).…”

Section: Pineal Cystsmentioning

confidence: 99%

Neuroimaging in emergency: a review of possible role of pineal gland disease

et al. 2019

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The pineal gland can be involved in a variety of neoplastic and congenital masses and tumors. Pineal gland neoplasms occur more frequently in children, accounting for 3-8% of intracranial tumors in the pediatric population. Pineal cysts are small lesions usually asymptomatic and encountered incidentally.Pathologic processes involving the pineal region produce signs and symptoms related to the mass effect on the adjacent structures and invasion of surrounding structures. These include several acute symptoms, such as increased intracranial pressure syndrome from obstruction of the aqueduct and consequent hydrocephalus, and Parinaud syndrome. Pineal apoplexy is rare and refers to the sudden neurological deterioration following hemorrhage in the pineal gland, most commonly into a pineal cyst. Knowledge of the clinical presentation and imaging features of these lesions is essential to narrow the differential diagnosis, especially when presenting with acute onset.

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