Neuroimaging in emergency: a review of possible role of pineal gland disease

Abstract

The pineal gland can be involved in a variety of neoplastic and congenital masses and tumors. Pineal gland neoplasms occur more frequently in children, accounting for 3-8% of intracranial tumors in the pediatric population. Pineal cysts are small lesions usually asymptomatic and encountered incidentally. Pathologic processes involving the pineal region produce signs and symptoms related to the mass effect on the adjacent structures and invasion of surrounding structures. These include several acute symptoms, such as increased intracranial pressure syndrome from obstruction of the aqueduct and consequent hydrocephalus, and Parinaud syndrome. Pineal apoplexy is rare and refers to the sudden neurological deterioration following hemorrhage in the pineal gland, most commonly into a pineal cyst. Knowledge of the clinical presentation and imaging features of these lesions is essential to narrow the differential diagnosis, especially when presenting with acute onset.

Keywords: Brain tumors; emergency; magnetic resonance imaging (MRI); pineal gland.

Figure 1

Axial FLAIR (A), DWI (B), sagittal T2 (C) and Gd-enhanced T1 (D) images of a 23-year-old boy with acute onset of headache and dizziness. MRI findings show the presence of a cystic lesion in the pineal gland region. Note the hyperintense signal on FLAIR sequence (arrowhead) and the incomplete wall enhancement after gadolinium (arrow). There are no signs of water diffusion restriction. DWI, diffusion weighted imaging.

Figure 2

Sagittal contrast-enhanced T1 sequences of a young patient with a homogeneously enhancing pineal mass (A). The lesion appears almost completely vanished after 1 month (arrow) (B).