Spontaneous pineal apoplexy in a pineal parenchymal tumor of intermediate differentiation.
Bottom Line: Pineal apoplexy is a rare clinical presentation of pineal parenchymal tumors.The paresis required an expeditious tumor resection.Clinical and radiological evidence of the cure 5 years post-surgery is available.
Affiliation: Nepean Hospital, Kingswood, NSW 2747, Australia;
Pineal apoplexy is a rare clinical presentation of pineal parenchymal tumors. We report the curative treatment of a case of pineal parenchymal tumor of intermediate differentiation with spontaneous apoplectic hemorrhage. This case is shown through computed tomography and magnetic resonance imaging of the brain, and is confirmed via histopathological studies. Recurrent upward gaze paresis was observed after the stereotactic biopsy. The paresis required an expeditious tumor resection. The mechanism of the pineal apoplectic hemorrhage remains unclear although it has been observed in different pineal region lesions. Clinical and radiological evidence of the cure 5 years post-surgery is available.
No MeSH data available.
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Mentions: A previously healthy 31-year-old woman presented sudden-onset headaches, vomiting, and photophobia. She experienced a progressively worsening headache for 5 days before the hospital presentation. The neurological examination revealed no abnormalities except for an upward conjugate gaze paresis (Parinaud’s syndrome). The computed tomography (CT) of the brain showed a 2.0 cm × 2.5 cm well-circumscribed hemorrhagic pineal lesion with contrast enhancement and an obstructive hydrocephalus. Magnetic resonance imaging (MRI) of the brain confirmed the hemorrhagic pineal lesion (Figure 1). A ventriculoperitoneal shunt was inserted to alleviate the effects of the obstructive hydrocephalus. Laboratory investigations conducted on the same day revealed within-normal ranges, including the coagulation studies. The tumor markers in the serum and cerebrospinal fluid (CSF), including the beta subunit of human chorionic gonadotropin and alpha-fetoprotein, were also normal. No malignant cells were found in the CSF cytology. The patient was then discharged from the hospital and was scheduled for a stereotactic biopsy of the pineal lesion 2 weeks later. Her upward conjugate gaze paresis was completely resolved on the second admission. She developed a recurrent upward conjugate gaze paresis, which was most likely caused by a post-biopsy intra-tumoral hemorrhage, a day after the biopsy. She then underwent craniotomy to have the lesion excised through the infratentorial supracerebellar approach. Complete macroscopic excision was achieved. The immediate post-operative CT scan showed complete tumor resection and resolution of the hydrocephalus. No post-operative complications were found. The patient was discharged 3 weeks later when the craniotomy showed no neurological deficits.
No MeSH data available.