Resting Tremor Secondary to a Pineal Cyst: Case Report and Review of the Literature

Morgan, Jonathan T.; Scumpia, Alexander J.; Webster, Toni M.; Mittler, Mark A.; Edelman, Morris; Schneider, Steven J.

doi:10.1159/000121382

Cited by 30 publications

(5 citation statements)

References 37 publications

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“…In our practice, we would limit the signs and symptoms that may be confidently attributed to a pineal cyst to Parinaud syndrome, focal cranial neuropathies, or signs and symptoms due to hydrocephalus resulting from aqueductal compression. There have been reports of pineal cysts associated with various symptoms and syndromes, including resting tremor, 43 retinoblastoma, 27,53,57 polycystic kidney disease, 1 Aicardi syndrome, 2,44 precocious puberty, 14,21,32 and even schizophrenia. 13 We doubt there are any causal associations between pineal cysts and these various conditions.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and natural history of pineal cysts in adults

Al-Holou¹,

Terman²,

Kilburg³

et al. 2011

JNS

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Object We reviewed our experience with pineal cysts to define the natural history and clinical relevance of this common intracranial finding. Methods The study population consisted of 48,417 consecutive patients who underwent brain MR imaging at a single institution over a 12-year interval and who were over 18 years of age at the time of imaging. Patient characteristics, including demographic data and other intracranial diagnoses, were collected from cases involving patients with a pineal cyst. We then identified all patients with pineal cysts who had been clinically evaluated at our institution and who had at least 6 months of clinical and imaging follow-up. All inclusion criteria for the natural history analysis were met in 151 patients. Results Pineal cysts measuring 5 mm or larger in greatest dimension were found in 478 patients (1.0%). Of these, 162 patients were male and 316 were female. On follow-up MR imaging of 151 patients with pineal cyst at a mean interval of 3.4 years from the initial study, 124 pineal cysts remained stable, 4 increased in size, and 23 decreased in size. Cysts that were larger at the time of initial diagnosis were more likely to decrease in size over the follow-up interval (p = 0.004). Patient sex, patient age at diagnosis, and the presence of septations within the cyst were not significantly associated with cyst change on follow-up. Conclusions Follow-up imaging and neurosurgical evaluation are not mandatory for adults with asymptomatic pineal cysts.

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Section: Discussionmentioning

confidence: 99%

Prevalence and natural history of pineal cysts in adults

Al-Holou¹,

Terman²,

Kilburg³

et al. 2011

JNS

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“…4,14,26,43,46 Pineal apoplexy (caused by hemorrhage), Parinaud's phenomenon (caused by compression of the superior colliculus), parkinsonian symptoms, choroid plexus papilloma formation, aseptic meningitis (due to cyst rupture), pseudo-precocious puberty (due to immaturity of the hypothalamic-gonadal axis), and diabetes insipidus are less frequent yet reported symptoms. 21,26,30,31,37,38,41 There is also thought to be a hormonal and melatonin imbalance in most of these patients with headaches. In our patient population, we found that headache was one of the most common indications for undergoing MRI, with a total of 16 patients (20%) presenting with this symptom.…”

Section: Discussionmentioning

confidence: 99%

Pineal cysts and other pineal region malignancies: determining factors predictive of hydrocephalus and malignancy

Starke

Cappuzzo²,

Erickson³

et al. 2017

Journal of Neurosurgery

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OBJECTIVE Cystic lesions of the pineal gland are most often uncomplicated benign lesions with typical MRI characteristics. The authors aimed to study pineal lesion characteristics on MRI to better distinguish benign pineal cysts from other pineal region malignancies as well as to determine which characteristics were predictive of the latter malignancies. They also aimed to study risk factors predictive of hydrocephalus or malignancy in patients harboring these lesions. METHODS The authors performed a retrospective review of a prospectively compiled database documenting the outcomes of patients with suspected pineal cysts on MRI who had presented in the period from 1998 to 2004. Inherent patient and lesion characteristics were assessed in a univariate logistic regression analysis to predict the following dependent variables: development of hydrocephalus, biopsy-confirmed malignancy, and intervention. Possible inherent patient and lesion characteristics included age, sex, T1 and T2 MRI signal pattern, contrast enhancement pattern, presence of cyst, presence of blood, complexity of lesion, presence of calcification, and duration of follow-up. Inherent patient and lesion characteristics that were predictive in the univariate analysis (p < 0.15) were included in the multivariable logistic regression analysis. RESULTS Of the 79 patients with benign-appearing pineal cysts, 26 (33%) were male and 53 (67%) were female, with a median age of 38 years (range 9-86 years). The median cyst radius was 5 mm (range 1-20 mm). Two patients (2.5%) had evidence of calcifications, 7 (9%) had multicystic lesions, and 25 (32%) had some evidence of contrast enhancement. The median follow-up interval was 3 years (range 0.5-13 years). Seven patients (9%) had an increase in the size of their lesion over time. Eight patients (10%) had a hemorrhage, and 11 patients (14%) developed hydrocephalus. Nine (11%) received ventriculoperitoneal shunts for the development of hydrocephalus, and 12 patients (16%) were found to have malignancies following biopsy or resection. In the multivariate analysis, contrast enhancement on MRI (OR 1.6, 95% CI 2.86-74.74, p = 0.013) and hemorrhage (OR 26.9, 95% CI 3.4-212.7, p = 0.022) were predictive of hydrocephalus. Increasing lesion size and hydrocephalus were near perfect predictors of malignancy and thus were removed from multivariate analysis. In addition, contrast enhancement on MRI (OR 8.8, 95% CI 2.0-38.6, p = 0.004) and hemorrhage (OR 6.8, 95% CI 1.1-40.5, p = 0.036) were predictive of malignancy. CONCLUSIONS Although cystic abnormalities of the pineal gland are often benign lesions, they are frequently monitored over time, as other pineal region pathologies may appear similarly on MRI. Patients with growing lesions, contrast enhancement, and hemorrhage on MRI are more likely to develop hydrocephalus and have malignant pathology on histological examination and should therefore be followed up with serial MRI with a lower threshold for neurosurgical intervention.

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“…In pineal cysts, headache and other symptoms of raised ICP are common. Morgan et al42 present a young female with new-onset resting tremor secondary to a pineal cyst. A possible explanation for the tremor could be the disturbance of the microvasculature surrounding the nigro-striatal-pallidal system.…”

Section: Cysts Vascular Malformations and Tumorsmentioning

confidence: 99%