Pineal apoplexy is rare and refers to the sudden neurological deterioration following hemorrhage in the pineal region, most commonly into a pineal cyst.
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Epidemiology
The condition is rare and since it results from bleeding from or into an underlying pineal region mass, no single demographic can be identified.
Clinical presentation
As is the case with the far more common pituitary apoplexy, the term pineal apoplexy refers to a sudden neurological event similar to, and sometimes due to, subarachnoid hemorrhage. Patients develop a sudden severe headache, with associated features including drop in conscious level and meningism.
Pathology
Etiology
Underlying lesions include:
- pineal cyst (most common)
- pineal tumor
- vascular malformation
Radiographic features
CT
- visualization of blood
- acute hemorrhage may be seen as a hyperattenuating lesion in the pineal region
- hematocrit effect may be visible (gradual shading or fluid fluid level)
- effects of enlargement
- normal pineal calcification may be displaced
- obstruction of aqueduct leading to hydrocephalus
MRI
MR findings in the pineal apoplexy follow the typical findings of intracranial hematoma at different ages (see aging of blood on MRI).
A pineal cyst accident is the most common cause of pineal apoplexy, hemorrhage may frequently appear as hematocrit level in a pineal cyst.
Treatment and prognosis
Surgical excision is believed to be the most effective treatment that reduces the risk of recurrence and complications, but stereotactic aspiration has been also practiced in some studies 4.
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