Pineal apoplexy

Last revised by Dr Yahya Baba on 25 Aug 2021

Pineal apoplexy is rare and refers to the sudden neurological deterioration following hemorrhage 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.

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. 

Underlying lesions include:

  • 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

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.

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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Cases and figures

  • Case 1: CT
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  • Case 1: MRI (T2)
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  • Case 2
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