About pineal cysts, symptomatic

What is pineal cysts, symptomatic?

Pineal cysts are benign (non-cancerous) fluid-filled sacs located in the region of the brain that contains the pineal gland. Small pineal cysts (.5 cm or smaller) are common occurrences, often found incidentally on routine neurological exams. Small pineal cysts rarely cause symptoms (asymptomatic). Larger pineal cysts are rare findings that may cause a variety of symptoms (symptomatic). Symptoms may include headaches, increased pressure on the brain because of accumulation of excessive cerebrospinal fluid (hydrocephalus), and vision abnormalities. Large symptomatic pineal cysts may potentially cause serious conditions such as seizures and loss of consciousness. The exact cause of symptomatic pineal cysts is unknown.



What are the symptoms for pineal cysts, symptomatic?

Altered visual perception symptom was found in the pineal cysts, symptomatic condition

Pineal cysts, Symptomatic are commonly found in individuals in their 40s. Cysts refer to the closed structures formed by one or more layers of tissues filled with fluid. Pineal cysts are made of the inner layer of gliotic cells, a middle layer of pineal parenchyma, and an outer layer of connective tissue. The fluid is proteinaceous. Cysts are either typical (unilocular) or atypical (multilocular with septations). Usually, the cysts remain dormant for nearly a decade without causing symptoms, and some may shrink over time. The size of symptomatic cysts varies between 7 and 45 mm in diameter.

Symptoms
The most common symptoms are
1. Paroxysmal Headache that is not of typical migraine pattern
2. Intermittent Nausea or Vomiting
3. Visual disturbances, such as blurred vision, altered visual perception, and graying of colors
4. Transient impaired conscious level
5. Gait instability
6. Hypersomnolence: significant episodes of sleepiness even after sufficient quality sleep.
Less frequently, patients may show
1. Ataxia
2. Motor and sensory impairment
3. Mental and emotional disturbances
4. Epilepsy
5. Circadian rhythm disturbances
Hypothalamic dysfunction of precocious puberty: early activation of the pulsatile gonadotropin-releasing hormone.
In females, symptoms worsen during pregnancy after gaining weight. Commonly, the worsening occurs in the morning.

Symptoms
Paroxysmal Headache that is not of typical migraine pattern,Intermittent Nausea or vomiting,Visual disturbances, such as blurred vision, altered visual perception, and graying of colors,Transient impaired conscious level,Gait instability,Hypersomnolence: significant episodes of sleepiness even after sufficient quality sleep,Less frequently, patients may show ataxia, motor and sensory impairment, mental and emotional disturbances, epilepsy, circadian rhythm disturbances and hypothalamic dysfunction of precocious puberty: early activation of the pulsatile gonadotropin-releasing hormone,In females, symptoms worsen during pregnancy after gaining weight. Commonly, the worsening occurs in the morning
Conditions
Fluid-filled spaces within the pineal gland
Drugs
NA



What are the causes for pineal cysts, symptomatic?

Pineal cysts, Symptomatic are sac-like structures formed in the pineal gland, and contain fluid. The pineal gland is located in the midline of the brain and plays a crucial role in the regulation of the sleep-wake cycle. Pineal cysts are commonly found in adults that are in their 40s. Initially, they remain asymptomatic for many years; the onset of symptoms occurs when the size of the cysts increases beyond 10 mm.
The patients commonly present headaches, vertigo, visual and oculomotor disturbances, and obstructive hydrocephalus. Less frequently, patients present with ataxia, motor and sensory impairment, mental and emotional disturbances, epilepsy, circadian rhythm disturbances, hypothalamic dysfunction of precocious puberty, and recently described the occurrence of secondary parkinsonism.

Causes
1. The pineal gland is located deep inside the brain, surrounded by different types of structures, such as vascular tissues and the third ventricle. It complicates the access to the pineal cysts for biopsy through resection. Thus, it is not completely understood.
2. Several studies are underway to elucidate cellular activities that lead to the formation of cysts. 3. However, a study suggests that hormones play a role in cyst formation in women, especially during pregnancy.

Symptoms
Paroxysmal headache that is not of typical migraine pattern,Intermittent nausea or vomiting,Visual disturbances, such as blurred vision, altered visual perception, and graying of colors,Transient impaired conscious level,Gait instability,Hypersomnolence: significant episodes of sleepiness even after sufficient quality sleep,Less frequently, patients may show ataxia, motor and sensory impairment, mental and emotional disturbances, epilepsy, circadian rhythm disturbances and hypothalamic dysfunction of precocious puberty: early activation of the pulsatile gonadotropin-releasing hormone,In females, symptoms worsen during pregnancy after gaining weight. Commonly, the worsening occurs in the morning
Conditions
Fluid-filled spaces within the pineal gland
Drugs
NA



What are the treatments for pineal cysts, symptomatic?

Pineal cysts, Symptomatic are of two types: asymptomatic and symptomatic pineal cysts. Pineal cysts are structures in which one or more layers of tissues form a closed structure containing a fluid. Typically, pineal cysts are made of three layers: the inner layer of gliotic cells, an intermediate layer of pineal parenchyma, and the outer layer of connective tissue. Although, studies using high througout imaging techniques are underway to understand the cysts completely. Symptomatic pineal cysts vary from 7 to 45 mm in diameter.

Treatment
Currently, there is no consensus on management strategies for pineal cysts. The interventions for symptomatic pineal cysts depend on two scenarios as follows.
1. Symptomatic pineal cysts causing hydrocephalus:
The cases of pineal cysts with hydrocephalus present with elevated intracranial pressure and require endoscopic third ventriculostomy, and/or endoscopic fenestration of the pineal wall. A ventriculoperitoneal shunt is an alternative but not preferable due to high failure rates.
2. Non-hydrocephalic symptomatic pineal cysts:
Choosing surgical resection of pineal cysts is controversial, and the response from neurosurgeons across the world to the option of surgical intervention is heterogeneous. The reason is the complications associated with the surgery as the pineal cysts are close to vascular structures. The complications include venous or arterial hemorrhage, CSF leak, infections, meningitis, and patients may develop cognitive and visual impairments.
However, a recent meta-analysis studied the success profile of the surgical treatment. It showed that 93% of operated cases showed improvement of symptoms against the complications. There are two surgical approaches: supracerebellar infratentorial (SCIT) and occipital transtentorial (OTT). Of the two, SCIT was adopted in 90 % of the cases.

Symptoms
Paroxysmal headache that is not of typical migraine pattern,Intermittent nausea or vomiting,Visual disturbances, such as blurred vision, altered visual perception, and graying of colors,Transient impaired conscious level,Gait instability,Hypersomnolence: significant episodes of sleepiness even after sufficient quality sleep,Less frequently, patients may show ataxia, motor and sensory impairment, mental and emotional disturbances, epilepsy, circadian rhythm disturbances and hypothalamic dysfunction of precocious puberty: early activation of the pulsatile gonadotropin-releasing hormone,In females, symptoms worsen during pregnancy after gaining weight. Commonly, the worsening occurs in the morning
Conditions
Fluid-filled spaces within the pineal gland
Drugs
NA



What are the risk factors for pineal cysts, symptomatic?

Pineal cysts, Symptomatic are predominant in adults in their 40s. While pineal cysts are found in all age groups, they remain dormant for up to a decade before becoming symptomatic. They are benign structures. However, a doctor usually looks for the presence of neoplasm. The size of symptomatic cysts varies from 7 to 45 mm. The causes of the cysts are still unknown.

The patients commonly present headaches, vertigo, visual and oculomotor disturbances, and obstructive hydrocephalus. Less frequently, patients present with ataxia, motor and sensory impairment, mental and emotional disturbances, epilepsy, circadian rhythm disturbances, hypothalamic dysfunction of precocious puberty, and recently described the occurrence of secondary parkinsonism.

Risk factors
1. Symptomatic pineal cysts are not well elucidated for their structure and causes. Therefore, risk factors have not been assessed thoroughly.
2. Nevertheless, common observation of a trend from imaging of pineal cysts has revealed the involvement of hormones.
3. Females in the age group 20-30 years have been found to be more affected than males.
4. The hypothesis is that fluctuations in hormone levels are involved in the development and progression of cysts, especially during pregnancy.

Symptoms
Paroxysmal headache that is not of typical migraine pattern,Intermittent nausea or vomiting,Visual disturbances, such as blurred vision, altered visual perception, and graying of colors,Transient impaired conscious level,Gait instability,Hypersomnolence: significant episodes of sleepiness even after sufficient quality sleep,Less frequently, patients may show ataxia, motor and sensory impairment, mental and emotional disturbances, epilepsy, circadian rhythm disturbances and hypothalamic dysfunction of precocious puberty: early activation of the pulsatile gonadotropin-releasing hormone,In females, symptoms worsen during pregnancy after gaining weight. Commonly, the worsening occurs in the morning
Conditions
Fluid-filled spaces within the pineal gland
Drugs
NA



Is there a cure/medications for pineal cysts, symptomatic?

Pineal cysts, Symptomatic are benign structures found in the pineal gland region of the brain. Though pineal cysts are found in all age groups, the symptomatic form is predominant in adults in their 40s. Typically, pineal cysts are made of three layers: the inner layer of gliotic cells, the middle layer of pineal parenchyma, and the outermost layer of connective tissue. The causes of the cysts are unknown. However, hormonal fluctuations have been believed to cause cysts in women.
Cure/medication
1. There is no approved medication for symptomatic pineal cysts. Currently, there is no consensus on management strategies for pineal cysts.
2. Therefore, the decision of whether to undertake surgical interventions or not is controversial in most parts of the world. It is due to the severe complications associated with the surgeries, as the pineal cysts are close to critical structures such as arteries, third ventricles, and other critical brain structures.
3. There are two surgical options: endoscopic third ventriculostomy and fenestration of the pineal wall.
4. Fenestration is preferable and sufficient for less severe cases and has a lower success rate.
A meta-analytical study has shown endoscopic third ventriculostomy to improve symptoms in 93% of the patients who underwent surgery. There are two approaches to the surgery: SupraCerebellar InfraTentorial (SCIT) and Occipital TransTentorial (OTT). Of the two, SCIT was adopted in 90 % of the cases.

Symptoms
Paroxysmal headache that is not of typical migraine pattern,Intermittent nausea or vomiting,Visual disturbances, such as blurred vision, altered visual perception, and graying of colors,Transient impaired conscious level,Gait instability,Hypersomnolence: significant episodes of sleepiness even after sufficient quality sleep,Less frequently, patients may show ataxia, motor and sensory impairment, mental and emotional disturbances, epilepsy, circadian rhythm disturbances and hypothalamic dysfunction of precocious puberty: early activation of the pulsatile gonadotropin-releasing hormone,In females, symptoms worsen during pregnancy after gaining weight. Commonly, the worsening occurs in the morning
Conditions
Fluid-filled spaces within the pineal gland
Drugs
NA



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