Pineal apoplexy: imaging diagnosis and follow-up of three new cases.

phenomenon, being found on up to 40% of autopsy cases1. However, symptomatology as a result of these cysts is considerably rare. Mukherjee, Banerji and Sharma identified 74 cases in the literature1. Symptomatic pineal cysts present as one of three syndromes identified by Wisoff and Epstein2: (1) paroxysmal headache with gaze paresis, (2) chronic headache, gaze paresis, papilledema and hydrocephalus, and (3) pineal apoplexy with acute hydrocephalus. Pineal apoplexy is understood as an acute presentation of hemorrhage within a pineal cystic lesion. Of the three syndromes pineal apoplexy is the rarest and while poorly understood, can have the most catastrophic of consequences, resulting in sudden death3. Herein we report three cases with clinical and imaging findings suggestive of pineal gland apoplexy in the context of a discussion of the relevant literature.