T1 sagittal pre-gad T1 sagittal pre-gad later T2 axial later

Diagnosis: Hemorrhagic pineal cyst (presumed)

Up to 40% of routine autopsies demonstrate a pineal cyst; however, most of these remain asymptomatic. In a recent series of 19 patients with symptomatic pineal cysts, the MR characteristics were variable. The most typical appearance was low signal on T1 with high signal on T2. Gadolinium enhancement was observed in over half of the cases. Calcification was observed in about half of the patients who had a CT performed. Three of the patients had fluid levels compatible with hemorrhage. The preoperative diagnosis in most of the cases was pineal neoplasm. The patients in the series ranged in age from 15 to 46 years with 5 men and 15 women. Presenting symptoms included headache most commonly followed by diplopia, nausea and vomiting, papilledema, seizure, Parinaud syndrome, ataxia, and hemiparesis. Approximately 1/2 of the patients had evidence of hydrocephalous on imaging. Other entities to consider in the general differential of pineal masses in patients of this age include metastasis and primary pineal neoplasm, such as a pineocytoma. Appearance of heterogeneous signal with a fluid level in a stable sized pineal lesion is most compatible with a hemorrhagic pineal cyst. It was elected to follow the patient for any change in symptoms. Related Cases

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Pineal teratoma Pineal epidermoid Pineal mass