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J Neurol Surg A Cent Eur Neurosurg
DOI: 10.1055/s-0044-1786538
Review

Pineal Apoplexy: Highlighting the Causes, Treatment, and Outcome

Oday Atallah
1   Departemnt of Neurosurgery, Hannover Medical School, Hannover, Germany
,
Bipin Chaurasia 
2   Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
,
Amr Badary
3   Departemnt of Neurosurgery, Klinikum Dessau, Dessau-Roßlau, Germany
,
Lucio De Maria
4   Unit of Neurosurgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
5   Department of Neurosurgery, University of Brescia, Brescia, Italy
,
Yasser F. Almealawy
6   Faculty of Medicine, University of Kufa, Kufa, Iraq
,
Wireko Andrew Awuah
7   Faculty of Medicine, Sumy State University, Sumy, Ukraine
,
Wahab Moustafa
3   Departemnt of Neurosurgery, Klinikum Dessau, Dessau-Roßlau, Germany
,
Anil Ergen
8   Department of Neurosurgery, Derince Research Hospital, Kocaeli, Turkey
,
Marco Maria Fontanella 
4   Unit of Neurosurgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
5   Department of Neurosurgery, University of Brescia, Brescia, Italy
› Author Affiliations Funding None.
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Abstract

Background Pineal apoplexy, alternatively referred to as pineal hemorrhage or pineal gland hemorrhagic stroke, is an infrequent pathologic condition characterized by bleeding within the pineal gland. In this review, we encompass the primary factors contributing to this uncommon ailment.

Methods The retrieval of pertinent research, including patients with pineal apoplexy, was conducted through PubMed, Google Scholar, and Scopus databases. This study exclusively incorporated comprehensive articles written in the English language. The search encompassed the MeSH terms “pineal apoplexy” and “pineal hemorrhage.”

Results A total of 41 articles were identified, encompassing a collective sample size of 57 patients. The median age of the patients in the study was 30 years, with a range spanning from 1 to 73 years. There were 27 males, representing 47.4% of the participants. The study identified the most often reported symptoms as headache (49; 86%), nausea/vomiting (19; 33.3%), and Parinaud's syndrome (16; 28.1%). The treatment options encompass several approaches, including open resection, shunting, ventriculostomy, endoscopic aspiration, and conservative care. In the conducted study, a notable number of patients, amounting to 45 cases (78.9%), indicated an amelioration of their symptoms upon their discharge.

Conclusion Data from a cohort of 57 cases provide insights into symptoms, lesions, treatments, and outcomes. Management approaches range from conservative measures to surgical interventions, with prognosis hinged on timely intervention. This investigation serves as a valuable resource for clinicians and researchers, underscoring the need for early diagnosis before permanent neurologic dysfunction happens and tailored treatments for optimal outcomes in pineal apoplexy cases.

Keywords

pineal apoplexy - pineal hemorrhage - pineal cyst


Publication History

Received: 08 January 2024

Accepted: 27 March 2024

Article published online:
24 May 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Burres KP, Hamilton RD. Pineal apoplexy. Neurosurgery 1979; 4 (03) 264-268
    CrossrefPubMedGoogle Scholar
  • 2 Patel AJ, Fuller GN, Wildrick DM, Sawaya R. Pineal cyst apoplexy: case report and review of the literature. Neurosurgery 2005; 57 (05) E1066 , discussion E1066
    CrossrefPubMedGoogle Scholar
  • 3 Osborn RE, Deen HG, Kerber CW, Glass RF. A case of hemorrhagic pineal cyst: MR/CT correlation. Neuroradiology 1989; 31 (02) 187-189
    CrossrefPubMedGoogle Scholar
  • 4 Michielsen G, Benoit Y, Baert E, Meire F, Caemaert J. Symptomatic pineal cysts: clinical manifestations and management. Acta Neurochir (Wien) 2002; 144 (03) 233-242 , discussion 242
    CrossrefPubMedGoogle Scholar
  • 5 Musolino A, Cambria S, Rizzo G, Cambria M. Symptomatic cysts of the pineal gland: stereotactic diagnosis and treatment of two cases and review of the literature. Neurosurgery 1993; 32 (02) 315-320 , discussion 320–321
    CrossrefPubMedGoogle Scholar
  • 6 Lombardi D, Scheithauer BW, Villani RM, Giovanelli M, de Tribolet N. Cavernous haemangioma of the pineal region. Acta Neurochir (Wien) 1996; 138 (06) 678-683
    CrossrefPubMedGoogle Scholar
  • 7 Kim DS, Shim KW, Kim TG, Chang JH, Park YG, Choi JU. Pineal cavernous malformations: report of two cases. Yonsei Med J 2005; 46 (06) 851-858
    CrossrefPubMedGoogle Scholar
  • 8 Klein P, Rubinstein LJ. Benign symptomatic glial cysts of the pineal gland: a report of seven cases and review of the literature. J Neurol Neurosurg Psychiatry 1989; 52 (08) 991-995
    CrossrefPubMedGoogle Scholar
  • 9 Kobayashi S, Kamagata M, Nakamura M, Nakazato Y, Sasaki T. Pineal apoplexy due to massive hemorrhage associated with cavernous angioma: case report. Surg Neurol 2001; 55 (06) 365-371
    CrossrefPubMedGoogle Scholar
  • 10 Tamura Y, Yamada Y, Tucker A. et al. Endoscopic surgery for hemorrhagic pineal cyst following antiplatelet therapy: case report. Neurol Med Chir (Tokyo) 2013; 53 (09) 625-629
    CrossrefPubMedGoogle Scholar
  • 11 Werder GM, Razdan RS, Gagliardi JA, Chaddha SKB. Conservatively managed pineal apoplexy in an anticoagulated patient. Radiography 2008; 14: 69-72
    CrossrefPubMedGoogle Scholar
  • 12 Lombardi G, Poliani PL, Manara R. et al. Diagnosis and treatment of pineal region tumors in adults: a EURACAN overview. Cancers (Basel) 2022; 14 (15) 3646
    CrossrefPubMedGoogle Scholar
  • 13 Sawamura Y, Ikeda J, Ozawa M, Minoshima Y, Saito H, Abe H. Magnetic resonance images reveal a high incidence of asymptomatic pineal cysts in young women. Neurosurgery 1995; 37 (01) 11-15 , discussion 15–16
    CrossrefPubMedGoogle Scholar
  • 14 Jamieson KG. Excision of pineal tumors. J Neurosurg 1971; 35 (05) 550-553
    CrossrefPubMedGoogle Scholar
  • 15 Mukherjee KK, Banerji D, Sharma R. Pineal cyst presenting with intracystic and subarachnoid haemorrhage: report of a case and review of the literature. Br J Neurosurg 1999; 13 (02) 189-192
    CrossrefPubMedGoogle Scholar
  • 16 Bosnjak J, Budisić M, Azman D, Strineka M, Crnjaković M, Demarin V. Pineal gland cysts: an overview. Acta Clin Croat 2009; 48 (03) 355-358
    PubMedGoogle Scholar
  • 17 Koenigsberg RA, Faro S, Marino R, Turz A, Goldman W. Imaging of pineal apoplexy. Clin Imaging 1996; 20 (02) 91-94
    CrossrefPubMedGoogle Scholar
  • 18 Baba M, Sugiura K, Takizawa H. et al. Hematoma of the pineal region: a case report. No Shinkei Geka 1985; 13 (03) 337-342
    PubMedGoogle Scholar
  • 19 Baba Y, Gaillard F. Pineal apoplexy. 2013 . Accessed April 2, 2023 at: https://radiopaedia.org/articles/pineal-apoplexy
    PubMedGoogle Scholar
  • 20 Lazar ML, Clark K. Direct surgical management of masses in the region of the vein of Galen. Surg Neurol 1974; 2 (01) 17-21
    PubMedGoogle Scholar
  • 21 Sarikaya-Seiwert S, Turowski B, Hänggi D, Janssen G, Steiger HJ, Stummer W. Symptomatic intracystic hemorrhage in pineal cysts. Report of 3 cases. J Neurosurg Pediatr 2009; 4 (02) 130-136
    CrossrefPubMedGoogle Scholar
  • 22 Richardson JK, Hirsch CS. Sudden, unexpected death due to “pineal apoplexy.”. Am J Forensic Med Pathol 1986; 7 (01) 64-68
    CrossrefPubMedGoogle Scholar
  • 23 Goehner D, Soyland D, Vuong S, Trumble E. Pineal cyst apoplexy in an 8-year-old girl: case report and literature review. World Neurosurg 2020; 142: 159-166
    CrossrefPubMedGoogle Scholar
  • 24 Ausman JI, Malik GM, Dujovny M, Mann R. Three-quarter prone approach to the pineal-tentorial region. Surg Neurol 1988; 29 (04) 298-306
    CrossrefPubMedGoogle Scholar
  • 25 Kim E, Kwon SM. Pineal cyst apoplexy: a rare complication of common entity. Brain Tumor Res Treat 2020; 8 (01) 66-70
    CrossrefPubMedGoogle Scholar
  • 26 Asundi A, Tampieri D, Melançon D, Del Maestro R, Petrecca K, Cortes MD. Pineal apoplexy: imaging diagnosis and follow-up of three new cases. Can J Neurol Sci 2011; 38 (06) 931-933
    CrossrefPubMedGoogle Scholar
  • 27 Taraszewska A, Matyja E, Koszewski W, Zaczyński A, Bardadin K, Czernicki Z. Asymptomatic and symptomatic glial cysts of the pineal gland. Folia Neuropathol 2008; 46 (03) 186-195
    PubMedGoogle Scholar
  • 28 Yamamoto K, Omodaka T, Watanabe R, Kodaira M. A hemorrhagic pineal cyst with a bacterial meningitis-like manifestation and benign outcome. Intern Med 2013; 52 (24) 2817-2820
    CrossrefPubMedGoogle Scholar
  • 29 Horrax G. Extirpation of a huge pinealoma from a patient with pubertas praecox: a new operative approach. Arch Neurol Psychiatry 1937; 37: 385-397
    CrossrefPubMedGoogle Scholar
  • 30 Choy W, Kim W, Spasic M, Voth B, Yew A, Yang I. Pineal cyst: a review of clinical and radiological features. Neurosurg Clin N Am 2011; 22 (03) 341-351 , vii
    CrossrefPubMedGoogle Scholar
  • 31 Apuzzo ML, Davey LM, Manuelidis EE. Pineal apoplexy associated with anticoagulant therapy. Case report. J Neurosurg 1976; 45 (02) 223-226
    CrossrefPubMedGoogle Scholar
  • 32 Kobayashi S, Sugita K, Tanaka Y, Kyoshima K. Infratentorial approach to the pineal region in the prone position: Concorde position. Technical note. J Neurosurg 1983; 58 (01) 141-143
    CrossrefPubMedGoogle Scholar
  • 33 Poppen JL. The right occipital approach to a pinealoma. J Neurosurg 1966; 25 (06) 706-710
    CrossrefPubMedGoogle Scholar
  • 34 Mena H, Armonda RA, Ribas JL, Ondra SL, Rushing EJ. Nonneoplastic pineal cysts: a clinicopathologic study of twenty-one cases. Ann Diagn Pathol 1997; 1 (01) 11-18
    CrossrefPubMedGoogle Scholar
  • 35 Ahn ES, Goumnerova L. Endoscopic biopsy of brain tumors in children: diagnostic success and utility in guiding treatment strategies. J Neurosurg Pediatr 2010; 5 (03) 255-262
    CrossrefPubMedGoogle Scholar
  • 36 Little KM, Friedman AH, Fukushima T. Surgical approaches to pineal region tumors. J Neurooncol 2001; 54 (03) 287-299
    CrossrefPubMedGoogle Scholar
  • 37 Nimmagadda A, Sandberg DI, Ragheb J. Spontaneous involution of a large pineal region hemorrhagic cyst in an infant. Case report. J Neurosurg 2006; 104 (4, Suppl): 275-278
    PubMedGoogle Scholar
  • 38 Ueyama T, Al-Mefty O, Tamaki N. Bridging veins on the tentorial surface of the cerebellum: a microsurgical anatomic study and operative considerations. Neurosurgery 1998; 43 (05) 1137-1145
    CrossrefPubMedGoogle Scholar
  • 39 Sener RN. The pineal gland: a comparative MR imaging study in children and adults with respect to normal anatomical variations and pineal cysts. Pediatr Radiol 1995; 25 (04) 245-248
    CrossrefPubMedGoogle Scholar
  • 40 Berhouma M, Ni H, Delabar V. et al. Update on the management of pineal cysts: case series and a review of the literature. Neurochirurgie 2015; 61 (2–3): 201-207
    CrossrefPubMedGoogle Scholar
  • 41 Wisoff JH, Epstein F. Surgical management of symptomatic pineal cysts. J Neurosurg 1992; 77 (06) 896-900
    CrossrefPubMedGoogle Scholar
  • 42 Avery GJ, Lind CRP, Bok APL. Successful conservative operative management of pineal apoplexy. J Clin Neurosci 2004; 11 (06) 667-669
    CrossrefPubMedGoogle Scholar
  • 43 Maselli G, De Paulis D, Ricci A, Galzio RJ. Posterior cranial fossa tumors: results and prognostic factors in a consecutive series of 14 operated patients by occipital transtentorial approach. Surg Neurol Int 2012; 3: 85
    CrossrefPubMedGoogle Scholar
  • 44 Stein BM. The infratentorial supracerebellar approach to pineal lesions. J Neurosurg 1971; 35 (02) 197-202
    CrossrefPubMedGoogle Scholar
  • 45 Majeed K, Enam SA. Recurrent pineal apoplexy in a child. Neurology 2007; 69 (01) 112-114
    CrossrefPubMedGoogle Scholar
  • 46 Pastel DA, Mamourian AC, Duhaime AC. Internal structure in pineal cysts on high-resolution magnetic resonance imaging: not a sign of malignancy. J Neurosurg Pediatr 2009; 4 (01) 81-84
    CrossrefPubMedGoogle Scholar
  • 47 Fakhran S, Escott EJ. Pineocytoma mimicking a pineal cyst on imaging: true diagnostic dilemma or a case of incomplete imaging?. AJNR Am J Neuroradiol 2008; 29 (01) 159-163
    CrossrefPubMedGoogle Scholar
  • 48 Radovanovic I, Dizdarevic K, de Tribolet N, Masic T, Muminagic S. Pineal region tumors–neurosurgical review. Med Arh 2009; 63 (03) 171-173
    PubMedGoogle Scholar
  • 49 Poppen JL, Marino Jr R. Pinealomas and tumors of the posterior portion of the third ventricle. J Neurosurg 1968; 28 (04) 357-364
    CrossrefPubMedGoogle Scholar
  • 50 Lozier AP, Bruce JN. Surgical approaches to posterior third ventricular tumors. Neurosurg Clin N Am 2003; 14 (04) 527-545
    CrossrefPubMedGoogle Scholar
  • 51 Behari S, Garg P, Jaiswal S, Nair A, Naval R, Jaiswal AK. Major surgical approaches to the posterior third ventricular region: a pictorial review. J Pediatr Neurosci 2010; 5 (02) 97-101
    CrossrefPubMedGoogle Scholar
  • 52 Kodera T, Bozinov O, Sürücü O, Ulrich NH, Burkhardt JK, Bertalanffy H. Neurosurgical venous considerations for tumors of the pineal region resected using the infratentorial supracerebellar approach. J Clin Neurosci 2011; 18 (11) 1481-1485
    CrossrefPubMedGoogle Scholar
  • 53 Kanno T. Surgical pitfalls in pinealoma surgery. Minim Invasive Neurosurg 1995; 38 (04) 153-157
    Article in Thieme ConnectPubMedGoogle Scholar
  • 54 Page LK. The infratentorial-supracerebellar exposure of tumors in the pineal area. Neurosurgery 1977; 1 (01) 36-40
    CrossrefPubMedGoogle Scholar
  • 55 Oliveira J, Cerejo A, Silva PS, Polónia P, Pereira J, Vaz R. The infratentorial supracerebellar approach in surgery of lesions of the pineal region. Surg Neurol Int 2013; 4: 154
    CrossrefPubMedGoogle Scholar
  • 56 Rey-Dios R, Cohen-Gadol AA. A surgical technique to expand the operative corridor for supracerebellar infratentorial approaches: technical note. Acta Neurochir (Wien) 2013; 155 (10) 1895-1900
    CrossrefPubMedGoogle Scholar
  • 57 Ellenbogen RG, Moores LE. Endoscopic management of a pineal and suprasellar germinoma with associated hydrocephalus: technical case report. Minim Invasive Neurosurg 1997; 40 (01) 13-15 , discussion 16
    Article in Thieme ConnectPubMedGoogle Scholar
  • 58 Morgenstern PF, Souweidane MM. Pineal region tumors: simultaneous endoscopic third ventriculostomy and tumor biopsy. World Neurosurg 2013; 79 (2, Suppl): 18.e9-18.e13
    CrossrefPubMedGoogle Scholar
  • 59 Morgenstern PF, Osbun N, Schwartz TH, Greenfield JP, Tsiouris AJ, Souweidane MM. Pineal region tumors: an optimal approach for simultaneous endoscopic third ventriculostomy and biopsy. Neurosurg Focus 2011; 30 (04) E3
    CrossrefPubMedGoogle Scholar
  • 60 Al-Tamimi YZ, Bhargava D, Surash S. et al. Endoscopic biopsy during third ventriculostomy in paediatric pineal region tumours. Childs Nerv Syst 2008; 24 (11) 1323-1326
    CrossrefPubMedGoogle Scholar
  • 61 Chibbaro S, Di Rocco F, Makiese O. et al. Neuroendoscopic management of posterior third ventricle and pineal region tumors: technique, limitation, and possible complication avoidance. Neurosurg Rev 2012; 35 (03) 331-338 , discussion 338–340
    CrossrefPubMedGoogle Scholar
  • 62 Robinson S, Cohen AR. The role of neuroendoscopy in the treatment of pineal region tumors. Surg Neurol 1997; 48 (04) 360-365 , discussion 365–367
    CrossrefPubMedGoogle Scholar
  • 63 Roopesh Kumar SV, Mohanty A, Santosh V. et al. Endoscopic options in management of posterior third ventricular tumors. Childs Nerv Syst 2007; 23 (10) 1135-1145
    CrossrefPubMedGoogle Scholar
  • 64 Wong TT, Chen HH, Liang ML, Yen YS, Chang FC. Neuroendoscopy in the management of pineal tumors. Childs Nerv Syst 2011; 27 (06) 949-959
    CrossrefPubMedGoogle Scholar
  • 65 Depreitere B, Dasi N, Rutka J, Dirks P, Drake J. Endoscopic biopsy for intraventricular tumors in children. J Neurosurg 2007; 106 (5, Suppl): 340-346
    PubMedGoogle Scholar
  • 66 Oertel JMK, Baldauf J, Schroeder HWS, Gaab MR. Endoscopic options in children: experience with 134 procedures. J Neurosurg Pediatr 2009; 3 (02) 81-89
    CrossrefPubMedGoogle Scholar
  • 67 Mohanty A, Santosh V, Devi BI, Satish S, Biswas A. Efficacy of simultaneous single-trajectory endoscopic tumor biopsy and endoscopic cerebrospinal fluid diversion procedures in intra- and paraventricular tumors. Neurosurg Focus 2011; 30 (04) E4
    CrossrefPubMedGoogle Scholar
  • 68 Shahinian H, Ra Y. Fully endoscopic resection of pineal region tumors. J Neurol Surg B Skull Base 2013; 74 (03) 114-117
    Article in Thieme ConnectPubMedGoogle Scholar
  • 69 Uschold T, Abla AA, Fusco D, Bristol RE, Nakaji P. Supracerebellar infratentorial endoscopically controlled resection of pineal lesions: case series and operative technique. J Neurosurg Pediatr 2011; 8 (06) 554-564
    CrossrefPubMedGoogle Scholar
  • 70 Ferrer E, Santamarta D, Garcia-Fructuoso G, Caral L, Rumià J. Neuroendoscopic management of pineal region tumours. Acta Neurochir (Wien) 1997; 139 (01) 12-20 , discussion 20–21
    CrossrefPubMedGoogle Scholar
  • 71 Giordano M, Lüdemann WO, Stieglitz L. et al. Identification of venous variants in the pineal region with three-dimensional preoperative magnetic resonance imaging navigation in patients harbouring tumors in this area: significance for surgical approach to the lesion. Clin Neurol Neurosurg 2011; 113 (05) 387-392
    CrossrefPubMedGoogle Scholar
  • 72 Zacharia BE, Bruce JN. Stereotactic biopsy considerations for pineal tumors. Neurosurg Clin N Am 2011; 22 (03) 359-366 , viii
    CrossrefPubMedGoogle Scholar
  • 73 Osborn AG, Preece MT. Intracranial cysts: radiologic-pathologic correlation and imaging approach. Radiology 2006; 239 (03) 650-664
    CrossrefPubMedGoogle Scholar
  • 74 Atallah O, Chaurasia B. The brain region that is least prone to abscess: pineal gland. Ann Med Surg (Lond) 2023; 86 (01) 23-24
    CrossrefPubMedGoogle Scholar
  • 75 Atallah O, Badary A, Almealawy YF. et al. Non-colloid-cyst primary brain tumors: A systematic review of unexpected fatality. J Clin Neurosci 2024; 119: 129-140
    CrossrefPubMedGoogle Scholar
  • 76 Ayhan S, Bal E, Palaoglu S, Cila A. Pineal cyst apoplexy: report of an unusual case managed conservatively. Neurol Neurochir Pol 2011; 45 (06) 604-607
    CrossrefPubMedGoogle Scholar
  • 77 Storey M, Lilimpakis K, Grandal NS, Rajaraman C, Achawal S, Hussain M. Pineal cyst surveillance in adults: a review of 10 years' experience. Br J Neurosurg 2020; 34 (05) 565-568
    CrossrefPubMedGoogle Scholar
  • 78 McNeely PD, Howes WJ, Mehta V. Pineal apoplexy: is it a facilitator for the development of pineal cysts?. Can J Neurol Sci 2003; 30 (01) 67-71
    CrossrefPubMedGoogle Scholar
  • 79 Mattogno PP, Frassanito P, Massimi L. et al. Spontaneous regression of pineal lesions: ghost tumor or pineal apoplexy?. World Neurosurg 2016; 88: 64-69
    CrossrefPubMedGoogle Scholar
  • 80 Steinbok P, Dolman CL, Kaan K. Pineocytomas presenting as subarachnoid hemorrhage. Report of two cases. J Neurosurg 1977; Nov; 47 (05) 776-780
    CrossrefPubMedGoogle Scholar
  • 81 Higashi K, Katayama S, Orita T. Pineal apoplexy. J Neurol Neurosurg Psychiatry 1979; Nov; 42 (11) 1050-1105
    CrossrefPubMedGoogle Scholar
  • 82 Fujii T, Itakura T, Hayashi S, Komai N, Nakamine H, Saito K. Primary pineal choriocarcinoma with hemorrhage monitored by computerized tomography. Case report. J Neurosurg 1981; Sep; 55 (03) 484-487
    CrossrefPubMedGoogle Scholar
  • 83 Harada K, Hayashi T, Anegawa S, Torigoe R, Maeda K, Toda K, Sugita Y, Utsunomiya H. Pineocytoma with intratumoral hemorrhage following ventriculoperitoneal shunt--case report. Neurol Med Chir (Tokyo) 1993; Dec; 33 (12) 836-838
    CrossrefPubMedGoogle Scholar
  • 84 Turtz AR, Hughes WB, Goldman HW. Endoscopic treatment of a symptomatic pineal cyst: technical case report. Neurosurgery 1995; Nov; 37 (05) 1013-1014 ; discussion 1014-1015
    CrossrefPubMedGoogle Scholar
  • 85 Swaroop GR, Whittle IR. Pineal apoplexy: an occurrence with no diagnostic clinicopathological features. Br J Neurosurg 1998; Jun; 12 (03) 274-276
    CrossrefPubMedGoogle Scholar
  • 86 Lee KH, Lall RR, Chandler JP, Bigio EH, Mao Q. Pineal chordoid meningioma complicated by repetitive hemorrhage during pregnancy: case report and literature review. Neuropathology 2013; Apr; 33 (02) 192-198
    CrossrefPubMedGoogle Scholar
  • 87 Wang CC, Turner J, Steel T. Spontaneous pineal apoplexy in a pineal parenchymal tumor of intermediate differentiation. Cancer Biol Med 2013; Mar; 10 (01) 43-46
    PubMedGoogle Scholar
  • 88 Mehrzad R, Mishra S, Feinstein A, Ho MG. A new identified complication of intracystic hemorrhage in a large pineal gland cyst. Clin Imaging 2014; Jul-Aug; 38 (04) 515-517
    CrossrefPubMedGoogle Scholar
  • 89 Van Oosterhout WPJ, Haan J. Atypical Presentation of an Apoplexy in a Pineal Cyst. J Clin Case Rep 2015; 3: 2-2
    PubMedGoogle Scholar
  • 90 Mathur T. Case Report of Pineal Apoplexy in a Patient with Primary Headache Syndrome: To Treat or not to Treat. Clin Case Rep Int 2022; 6: 1258
    PubMedGoogle Scholar
  • 91 Karthik DK, Khardenavis V, Kulkarni S, Deshpande A. Pineal gland apoplexy mimicking as migraine-like headache. BMJ Case Rep 2018; Jun 29; 2018: bcr2018225187
    CrossrefPubMedGoogle Scholar
  • 92 O'Connell K, Crimmins D, Power S, Ligon KL, Cryan J, Beausang A. Pineal apoplexy due to pleomorphic variant pineocytoma. Clin Neuropathol 2019; Sep/Oct; 38 (05) 253-255
    CrossrefPubMedGoogle Scholar
  • 93 Majovsky M, Netuka D, Lipina R, Mraček J, Beneš V. Pineal Apoplexy: A Case Series and Review of the Literature. J Neurol Surg A Cent Eur Neurosurg 2022; Jan; 83 (01) 31-38
    Article in Thieme ConnectPubMedGoogle Scholar
  • 94 Shafqat A, AlGethami HJ, Shafqat S, Islam SSU. Pineal cyst apoplexy and memory loss: a novel complication. Radiol Case Rep 2022; Aug 5; 17 (10) 3739-3744
    CrossrefPubMedGoogle Scholar