Pineal apoplexy

Dr Jeremy Jones and A.Prof Frank Gaillard et al.

Pineal apoplexy is rare and refers to the sudden neurological deterioration following haemorrhage in the pineal region, most commonly into a pineal cyst

The condition is rare and since it results from bleeding from or into an underlying pineal region mass, no single demographic can be identified. Underlying lesions include:

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 haemorrhage. Patients develop a sudden severe headache, with associated features including drop in conscious level and meningism. 

  • visualisation of blood
    • acute hemorrhage may be seen as a hyperdense lesion in the pineal region
    • haematocrit 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

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, haemorrhage may frequently appear as hematocrit level in a pineal cyst.

Surgical excision is believed to be the most efective treatment that reduces the risk of recrrence and complications, but streotactic aspiration has been also practiced in some studies 4.

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Article information

rID: 22579
Section: Pathology
Synonyms or Alternate Spellings:

Cases and figures

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    Case 1 - CT
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    Case 1 - MRI : T2
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