{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T23:34:54Z","timestamp":1782257694062,"version":"3.54.5"},"reference-count":47,"publisher":"Georg Thieme Verlag KG","issue":"01","funder":[{"DOI":"10.13039\/501100003243","name":"Ministry of Health of the Czech Republic","doi-asserted-by":"crossref","award":["AZV NV19-04-00272"],"award-info":[{"award-number":["AZV NV19-04-00272"]}],"id":[{"id":"10.13039\/501100003243","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Ministry of Defense of the Czech Republic","award":["MO 1012, Q25"],"award-info":[{"award-number":["MO 1012, Q25"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg A Cent Eur Neurosurg"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Pineal apoplexy is a rare condition, with unknown incidence and clinical significance. To elucidate this clinical condition, we analyzed our own case series and performed a review of the literature.<\/jats:p><jats:p>\n          Methods\u2003We enrolled all patients with a hemorrhagic pineal apoplexy who were referred to our department between January 2000 and January 2020. Hemorrhagic pineal apoplexy was defined as the presence of fluid\u2013fluid levels inside the pineal cyst (PC) on an axial or sagittal magnetic resonance scan. In one patient, after PC apoplexy, we performed a circadian melatonin sampling from peripheral blood to determine the function of the pineal gland. The PubMed database was searched for publications using the terms \u201cpineal\u201d and \u201capoplexy.\u201d<\/jats:p><jats:p>\n          Results\u2003Eight patients were enrolled, of which three patients underwent surgical treatment and five patients were managed conservatively. One patient was tested for circadian melatonin secretion. Results confirmed melatonin secretion with preserved physiologic circadian rhythm.<\/jats:p><jats:p>Our search of the literature led us to 31 studies that comprised 30 patients with apoplectic PC, 9 with apoplectic pineal tumor, and 1 with bleeding into the normal pineal gland. Most patients presented with headache, nausea, and vomiting, less frequently with acute hydrocephalus and gaze palsy. Twenty patients with a PC underwent resection or aspiration. Two patients underwent shunt placement as the only procedure and five received both shunt and surgical removal. Six patients with a PC were observed without surgical treatment. All the nine patients with a pineal tumor were operated on. In indicated cases, four patients received radiation therapy and one received chemotherapy.<\/jats:p><jats:p>\n          Conclusion\u2003Clinical significance of hemorrhagic pineal apoplexy ranges from an asymptomatic course to rapid deterioration and death. In patients with mild symptoms, observation is indicated, whereas surgical treatment is reserved for severe cases presenting with obstructive hydrocephalus and includes cerebrospinal fluid diversion, resection of apoplectic pineal lesions, or both.<\/jats:p>","DOI":"10.1055\/s-0041-1723813","type":"journal-article","created":{"date-parts":[[2021,6,3]],"date-time":"2021-06-03T00:22:44Z","timestamp":1622679764000},"page":"031-038","source":"Crossref","is-referenced-by-count":10,"title":["Pineal Apoplexy: A Case Series and Review of the Literature"],"prefix":"10.1055","volume":"83","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7725-5181","authenticated-orcid":false,"given":"Martin","family":"Majovsky","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Neurooncology, First Medical School, Charles University, Military University Hospital Prague, Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Netuka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Neurooncology, First Medical School, Charles University, Military University Hospital Prague, Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radim","family":"Lipina","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4629-4732","authenticated-orcid":false,"given":"Jan","family":"Mra\u010dek","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen \u2013 Pilsen, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vladim\u00edr","family":"Bene\u0161","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Neurooncology, First Medical School, Charles University, Military University Hospital Prague, Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2021,6,2]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1212\/01.wnl.0000265058.35804.f6","article-title":"Recurrent pineal apoplexy in a child","volume":"69","author":"K Majeed","year":"2007","journal-title":"Neurology"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"66","DOI":"10.14791\/btrt.2020.8.e4","article-title":"Pineal cyst apoplexy: a rare complication of common entity","volume":"8","author":"E Kim","year":"2020","journal-title":"Brain Tumor Res Treat"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.wneu.2017.05.155","article-title":"Conservative and surgical treatment of patients with pineal cysts: prospective case series of 110 patients","volume":"105","author":"M M\u00e1jovsk\u00fd","year":"2017","journal-title":"World Neurosurg"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.jocn.2017.01.022","article-title":"Melatonin and cortisol secretion profile in patients with pineal cyst before and after pineal cyst resection","volume":"39","author":"M M\u00e1jovsk\u00fd","year":"2017","journal-title":"J Clin Neurosci"},{"issue":"02","key":"ref5","doi-asserted-by":"crossref","first-page":"223","DOI":"10.3171\/jns.1976.45.2.0223","article-title":"Pineal apoplexy associated with anticoagulant therapy. Case report","volume":"45","author":"M L Apuzzo","year":"1976","journal-title":"J Neurosurg"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1080\/02688699943970","article-title":"Pineal cyst presenting with intracystic and subarachnoid haemorrhage: report of a case and review of the literature","volume":"13","author":"K K Mukherjee","year":"1999","journal-title":"Br J Neurosurg"},{"issue":"03","key":"ref7","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1080\/02688699845140","article-title":"Pineal apoplexy: an occurrence with no diagnostic clinicopathological features","volume":"12","author":"G R Swaroop","year":"1998","journal-title":"Br J Neurosurg"},{"issue":"03","key":"ref8","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1007\/s007010200031","article-title":"Symptomatic pineal cysts: clinical manifestations and management","volume":"144","author":"G Michielsen","year":"2002","journal-title":"Acta Neurochir (Wien)"},{"issue":"06","key":"ref9","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1016\/j.jocn.2003.11.009","article-title":"Successful conservative operative management of pineal apoplexy","volume":"11","author":"G J Avery","year":"2004","journal-title":"J Clin Neurosci"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1017\/S031716710000247X","article-title":"Pineal apoplexy: is it a facilitator for the development of pineal cysts?","volume":"30","author":"P D McNeely","year":"2003","journal-title":"Can J Neurol Sci"},{"issue":"05","key":"ref11","doi-asserted-by":"crossref","first-page":"E1066","DOI":"10.1227\/01.NEU.0000179990.46401.66","article-title":"Pineal cyst apoplexy: case report and review of the literature","volume":"57","author":"A J Patel","year":"2005","journal-title":"Neurosurgery"},{"issue":"02","key":"ref12","doi-asserted-by":"crossref","first-page":"130","DOI":"10.3171\/2009.4.PEDS08309","article-title":"Symptomatic intracystic hemorrhage in pineal cysts. Report of 3 cases","volume":"4","author":"S Sarikaya-Seiwert","year":"2009","journal-title":"J Neurosurg Pediatr"},{"key":"ref13","first-page":"275","article-title":"Spontaneous involution of a large pineal region hemorrhagic cyst in an infant. Case report","volume":"104","author":"A Nimmagadda","year":"2006","journal-title":"J Neurosurg"},{"issue":"06","key":"ref14","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1017\/S0317167100012567","article-title":"Pineal apoplexy: imaging diagnosis and follow-up of three new cases","volume":"38","author":"A Asundi","year":"2011","journal-title":"Can J Neurol Sci"},{"issue":"06","key":"ref15","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1016\/S0028-3843(14)60129-8","article-title":"Pineal cyst apoplexy: report of an unusual case managed conservatively","volume":"45","author":"S Ayhan","year":"2011","journal-title":"Neurol Neurochir Pol"},{"issue":"11","key":"ref16","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1136\/jnnp.42.11.1050","article-title":"Pineal apoplexy","volume":"42","author":"K Higashi","year":"1979","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"09","key":"ref17","doi-asserted-by":"crossref","first-page":"625","DOI":"10.2176\/nmc.cr2012-0396","article-title":"Endoscopic surgery for hemorrhagic pineal cyst following antiplatelet therapy: case report","volume":"53","author":"Y Tamura","year":"2013","journal-title":"Neurol Med Chir (Tokyo)"},{"issue":"04","key":"ref18","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/j.clinimag.2014.03.009","article-title":"A new identified complication of intracystic hemorrhage in a large pineal gland cyst","volume":"38","author":"R Mehrzad","year":"2014","journal-title":"Clin Imaging"},{"key":"ref19","first-page":"bcr-2018","article-title":"Pineal gland apoplexy mimicking as migraine-like headache","volume":"2018","author":"D K Karthik","year":"2018","journal-title":"BMJ Case Rep"},{"issue":"01","key":"ref20","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.radi.2006.08.003","article-title":"Conservatively managed pineal apoplexy in an anticoagulated patient","volume":"14","author":"G M Werder","year":"2008","journal-title":"Radiography"},{"issue":"03","key":"ref21","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1227\/00006123-197903000-00015","article-title":"Pineal apoplexy","volume":"4","author":"K P Burres","year":"1979","journal-title":"Neurosurgery"},{"issue":"05","key":"ref22","doi-asserted-by":"crossref","first-page":"776","DOI":"10.3171\/jns.1977.47.5.0776","article-title":"Pineocytomas presenting as subarachnoid hemorrhage. Report of two cases","volume":"47","author":"P Steinbok","year":"1977","journal-title":"J Neurosurg"},{"issue":"12","key":"ref23","doi-asserted-by":"crossref","first-page":"836","DOI":"10.2176\/nmc.33.836","article-title":"Pineocytoma with intratumoral hemorrhage following ventriculoperitoneal shunt--case report","volume":"33","author":"K Harada","year":"1993","journal-title":"Neurol Med Chir (Tokyo)"},{"issue":"12","key":"ref24","doi-asserted-by":"crossref","first-page":"911","DOI":"10.2176\/nmc.37.911","article-title":"Pineocytoma with massive intratumoral hemorrhage after ventriculoperitoneal shunt: case report","volume":"37","author":"K Matsumoto","year":"1997","journal-title":"Neurol Med Chir (Tokyo)"},{"issue":"01","key":"ref25","first-page":"43","article-title":"Spontaneous pineal apoplexy in a pineal parenchymal tumor of intermediate differentiation","volume":"10","author":"C-C Wang","year":"2013","journal-title":"Cancer Biol Med"},{"issue":"03","key":"ref26","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1017\/S0317167100041287","article-title":"Malignant rhabdoid tumour of the pineal region","volume":"21","author":"M Muller","year":"1994","journal-title":"Can J Neurol Sci"},{"issue":"01","key":"ref27","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1097\/00000433-198603000-00014","article-title":"Sudden, unexpected death due to \u201cpineal apoplexy.\u201d","volume":"7","author":"J K Richardson","year":"1986","journal-title":"Am J Forensic Med Pathol"},{"issue":"05","key":"ref28","doi-asserted-by":"crossref","first-page":"253","DOI":"10.5414\/NP301196","article-title":"Pineal apoplexy due to pleomorphic variant pineocytoma","volume":"38","author":"K O'Connell","year":"2019","journal-title":"Clin Neuropathol"},{"issue":"03","key":"ref29","doi-asserted-by":"crossref","first-page":"484","DOI":"10.3171\/jns.1981.55.3.0484","article-title":"Primary pineal choriocarcinoma with hemorrhage monitored by computerized tomography. Case report","volume":"55","author":"T Fujii","year":"1981","journal-title":"J Neurosurg"},{"issue":"08","key":"ref30","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1136\/jnnp.52.8.991","article-title":"Benign symptomatic glial cysts of the pineal gland: a report of seven cases and review of the literature","volume":"52","author":"P Klein","year":"1989","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"03","key":"ref31","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1148\/radiol.2393050823","article-title":"Intracranial cysts: radiologic-pathologic correlation and imaging approach","volume":"239","author":"A G Osborn","year":"2006","journal-title":"Radiology"},{"issue":"02","key":"ref32","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/0899-7071(94)00079-4","article-title":"Imaging of pineal apoplexy","volume":"20","author":"R A Koenigsberg","year":"1996","journal-title":"Clin Imaging"},{"issue":"05","key":"ref33","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1227\/00006123-199511000-00025","article-title":"Endoscopic treatment of a symptomatic pineal cyst: technical case report","volume":"37","author":"A R Turtz","year":"1995","journal-title":"Neurosurgery"},{"issue":"02","key":"ref34","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1227\/00006123-199302000-00025","article-title":"Symptomatic cysts of the pineal gland: stereotactic diagnosis and treatment of two cases and review of the literature","volume":"32","author":"A Musolino","year":"1993","journal-title":"Neurosurgery"},{"issue":"01","key":"ref35","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/S1092-9134(97)80004-4","article-title":"Nonneoplastic pineal cysts: a clinicopathologic study of twenty-one cases","volume":"1","author":"H Mena","year":"1997","journal-title":"Ann Diagn Pathol"},{"issue":"02","key":"ref36","doi-asserted-by":"crossref","first-page":"133","DOI":"10.21037\/gs.2019.01.02","article-title":"Neuroimaging in emergency: a review of possible role of pineal gland disease","volume":"8","author":"F Bruno","year":"2019","journal-title":"Gland Surg"},{"key":"ref37","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.wneu.2015.12.080","article-title":"Spontaneous regression of pineal lesions: ghost tumor or pineal apoplexy?","volume":"88","author":"P P Mattogno","year":"2016","journal-title":"World Neurosurg"},{"issue":"08","key":"ref38","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1007\/s00701-016-2859-4","article-title":"Rapid regression of a symptomatic pineal region meningioma after presumed spontaneous central infarction","volume":"158","author":"L Galloway","year":"2016","journal-title":"Acta Neurochir (Wien)"},{"issue":"05","key":"ref39","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1177\/1971400916655480","article-title":"Vanishing pineal mass in a young patient without therapy: case report and review of the literature","volume":"29","author":"L Patriarca","year":"2016","journal-title":"Neuroradiol J"},{"issue":"06","key":"ref40","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.3171\/2011.6.JNS11506","article-title":"Prevalence and natural history of pineal cysts in adults","volume":"115","author":"W N Al-Holou","year":"2011","journal-title":"J Neurosurg"},{"issue":"01","key":"ref41","first-page":"35","article-title":"Clinical and neurophysiological changes in patients with pineal region expansions","volume":"37","author":"S Hajnsek","year":"2013","journal-title":"Coll Antropol"},{"issue":"07","key":"ref42","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1212\/WNL.41.7.1034","article-title":"Non-neoplastic pineal cysts","volume":"41","author":"M R Fetell","year":"1991","journal-title":"Neurology"},{"issue":"06","key":"ref43","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1007\/s002340000308","article-title":"Cystic lesions of the pineal region--MRI and pathology","volume":"42","author":"U Engel","year":"2000","journal-title":"Neuroradiology"},{"key":"ref44","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.jns.2016.06.028","article-title":"Increased pulsatile intracranial pressure in patients with symptomatic pineal cysts and magnetic resonance imaging biomarkers indicative of central venous hypertension","volume":"367","author":"P K Eide","year":"2016","journal-title":"J Neurol Sci"},{"key":"ref45","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1016\/j.wneu.2017.08.106","article-title":"Regression of pineal lesions: spontaneous or iatrogenic? A case report and systematic literature review","volume":"108","author":"S Schipmann","year":"2017","journal-title":"World Neurosurg"},{"key":"ref46","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1007\/PL00013724","article-title":"Spontaneous regression of a symptomatic pineal cyst after endoscopic third-ventriculostomy","volume":"17","author":"A Di Chirico","year":"2001","journal-title":"Childs Nerv Syst"},{"issue":"01","key":"ref47","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1007\/s10143-005-0423-4","article-title":"Review of the literature regarding the relationship of rebleeding and external ventricular drainage in patients with subarachnoid hemorrhage of aneurysmal origin","volume":"29","author":"K N Fountas","year":"2006","journal-title":"Neurosurg Rev"}],"container-title":["Journal of Neurological Surgery Part A: Central European Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0041-1723813.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,2]],"date-time":"2022-02-02T00:55:48Z","timestamp":1643763348000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0041-1723813"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,2]]},"references-count":47,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2022,2,1]]},"published-print":{"date-parts":[[2022,1]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0041-1723813","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2193-6315","2193-6323"],"issn-type":[{"value":"2193-6315","type":"print"},{"value":"2193-6323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,2]]}}}