ABSTRACT
@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Pineal region tumor is a rare and reportable case. Incidence rate adults is 0.025 in 10,000 hence there is no established guidelines among adults for diagnosis and management of this case.<br /><strong>CASE:</strong> A case of a 20-year-old male with a two-month history of intermittent headache, occipital area with VAS 5/10,increasing in severity. Until two days prior to admission with severe headache VAS 9-10/10, occipital, and nonradiating.Patient noted episodes of projectile vomiting hence,admitted. Patient presented with non-lateralizing symptoms but noted papilledema and parinaud syndrome.Cranial MRI with contrast revealed a 2.5cm pineal gland tumor with obstructive hydrocephalus. Serum AFP (alpha-fetoprotein ) and beta-HCG (beta subunit of human chorionic gonadotropin) were requested and revealed elevated levels.The patient underwent endoscopic third ventriculostomy but no biopsy was done due to high risk of bleeding. Patient underwent series of radiotherapy and was advised to undergo chemotherapy but patient refused. Patient had improved upward gaze but with residuals, no recurrence of headache or vomiting, had normalization of the serum tumor markers but noted increase in size of the tumor despite radiotherapy.<br /><strong>CONCLUSION:</strong> Case reports of pineal region tumors will help doctors in the primary hospitals diagnose such cases and differentiate it from benign causes of headache. This will aid in early referral to specialists and early intervention.</p>
Subject(s)
Humans , Male , Adult , Pinealoma , alpha-Fetoproteins , Chorionic Gonadotropin, beta Subunit, Human , Ventriculostomy , Chorionic Gonadotropin , Biomarkers, Tumor , Papilledema , Hydrocephalus , Headache , Vomiting , Ocular Motility DisordersABSTRACT
BACKGROUND: Pineal region tumor is a rare and reportable case. Incidence rate adults is 0.025 in 10,000 hence there is no established guidelines among adults for diagnosis and management of this case.CASE: A case of a 20-year-old male with a two-month history of intermittent headache, occipital area with VAS 5/10,increasing in severity. Until two days prior to admission with severe headache VAS 9-10/10, occipital, and nonradiating.Patient noted episodes of projectile vomiting hence,admitted. Patient presented with non-lateralizing symptoms but noted papilledema and parinaud syndrome.Cranial MRI with contrast revealed a 2.5cm pineal gland tumor with obstructive hydrocephalus. Serum AFP (alpha-fetoprotein ) and beta-HCG (beta subunit of human chorionic gonadotropin) were requested and revealed elevated levels.The patient underwent endoscopic third ventriculostomy but no biopsy was done due to high risk of bleeding. Patient underwent series of radiotherapy and was advised to undergo chemotherapy but patient refused. Patient had improved upward gaze but with residuals, no recurrence of headache or vomiting, had normalization of the serum tumor markers but noted increase in size of the tumor despite radiotherapy.CONCLUSION: Case reports of pineal region tumors will help doctors in the primary hospitals diagnose such cases and differentiate it from benign causes of headache. This will aid in early referral to specialists and early intervention.
Subject(s)
Humans , Male , Adult , Pinealoma , alpha-Fetoproteins , Chorionic Gonadotropin, beta Subunit, Human , Ventriculostomy , Chorionic Gonadotropin , Biomarkers, Tumor , Papilledema , Hydrocephalus , Headache , Vomiting , Ocular Motility DisordersABSTRACT
BACKGROUND: Pineal region tumor is a rare and reportable case. Incidence rate adults is 0.025 in 10,000 hence there is no established guidelines among adults for diagnosis and management of this case.CASE: A case of a 20-year-old male with a two-month history of intermittent headache, occipital area with VAS 5/10,increasing in severity. Until two days prior to admission with severe headache VAS 9-10/10, occipital, and nonradiating.Patient noted episodes of projectile vomiting hence,admitted. Patient presented with non-lateralizing symptoms but noted papilledema and parinaud syndrome.Cranial MRI with contrast revealed a 2.5cm pineal gland tumor with obstructive hydrocephalus. Serum AFP (alpha-fetoprotein ) and beta-HCG (beta subunit of human chorionic gonadotropin) were requested and revealed elevated levels.The patient underwent endoscopic third ventriculostomy but no biopsy was done due to high risk of bleeding. Patient underwent series of radiotherapy and was advised to undergo chemotherapy but patient refused. Patient had improved upward gaze but with residuals, no recurrence of headache or vomiting, had normalization of the serum tumor markers but noted increase in size of the tumor despite radiotherapy.CONCLUSION: Case reports of pineal region tumors will help doctors in the primary hospitals diagnose such cases and differentiate it from benign causes of headache. This will aid in early referral to specialists and early intervention.
Subject(s)
Humans , Male , Adult , Pinealoma , Chorionic Gonadotropin, beta Subunit, Human , Ventriculostomy , Chorionic Gonadotropin , Biomarkers, Tumor , Papilledema , Hydrocephalus , Ocular Motility DisordersABSTRACT
Objetivo: Describir los estrabismo asociados al Síndrome de Parinaud (SP). Métodos: Se estudiaron pacientes con SP de 1998 a 2004 asociados a otros estrabismos. Resultados: Total 18 pacientes, 6 mujeres y 12 hombres. Edad: 28 años DE 22 (10; 1C 95 por ciento). Lesión al III nervio craneal en 15 pacientes (79 por ciento), II nervio: 8 pacientes (44.4 por ciento), VII nervio: 3 pacientes, hemiparesia: 3, lesión a IV nervio 2, parálisis bilateral de III nervio 2, nistagmus 2, Síndrome de foville 2, y síndrome de uno y medio 1 paciente. Causas: Accidente vascular cerebral 4, uno de ellos asociado a infarto agudo de miocardio, traumatismo cráneo-encefálico 3, tumor cerebral 6, neurocisticercosis 2. Se obtuvo ortoposición con toxina botulínica en 1.72 +/- 1.1 (0.65 IC 95) y cirugía en 9, mejoría espontánea 1. Conclusiones: Identificar el diagnóstico topográfico y pronóstico de la lesión cerebral asociada a SP es muy importante en el control y vigilancia del paciente así como para ofrecer una rehabilitación mas dirigida.
Objective: To describe the causes of Parinaud syndrome (PS) with diplopia to determine a topographic diagnosis and prognosis. Method: We studied patients with SP from January 1980 to January 2004; causes and treatment. We identified all strabismus associated to PS. Results: We included 18 patients with diplopia, 6 female and 12 male. Age: 28 years old, SD 22 (10; CI 95 percent). Related strabismus: III nerve palsy in 15 patients (79 percent), optical nerve damage in 8 (44.4 percent), VII nerve palsy in 3, IV nerve palsy 2, bilateral III nerve palsy 2, nystagmus 2, Foville syndrome 2, One and half syndrome 1. Causes: Tumor 6, brain stroke 4, cranial trauma 3, neurocisticercosis 2. Ortoposition with botulinum toxin treatment was obtained with 1.72 +/-1.1 (0.65; IC 95 percent) inyections. Surgery was done in 9 patients, only one patient had spontaneous resolution of diplopia and SP. Conclusions: To identify the topographic diagnosis and prognosis of brain diseases in PS is very important to complete the study of strabismus. In this way we can know more about of damage extension and we can identify recurrences quickly to offer a better control.