Pineal cyst apoplexy in a pregnant female. Case Report

Abstract

Background: Pineal cyst is an uncommon condition in pregnancy. It is often encountered as an incidental finding in brain imaging. Most of pineal cysts are benign and asymptomatic. Bleeding inside these cysts is very rare in pregnancy. Clinical presentation: A 30-year-old female patient with no significant past medical history, presented to the emergency department at 36 weeks gestation with an episode of transient unilateral headache. Headache was associated with dizziness and left arm ascending numbness. Neurological examination was normal. Investigations: She has a history of a known pineal cyst. CT head was obtained, reviewed and compared to previous scans 7 years ago. It showed that the pineal cyst had a suspected bleeding. Management: The patient was admitted to the neurosurgery department for conservative management without any surgery and few days later, symptoms gradually improved. Follow-up: Three weeks later, the patient reported spontaneous improvement of the presenting symptoms. The decision was to proceed with continued watchful follow-up and awaiting a caesarian section delivery. Patient returned for follow up three months later without any symptoms. Following delivery, the patient remained asymptomatic and no further problems occurred during the postpartum period. Conclusion: Pineal cyst apoplexy is a relatively rare condition and it usually affects young adult females, however, the exact relation to pregnancy and the effect of apoplexy on the course of pregnancy is not well defined.