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headache

My 16 year old girl has a 1.3 cm x 1 cm pineal brain cyst.
She has headaches, dizziness, blurred and double vision, nausea, and her hands shake some.
Can anyone tell me is this all part of a pineal cyst? How dangerous is surgery for this? Her double and blurred vision has became more often in the last week and her headaches never go away. She is on pain, nausea and steroids will have another MRI next week. Please let me know if anyone has anymore information they can share with me.  
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Avatar_n_tn
Hi,
Most often than NOT brain related tumors,may it be small or big ,manifests with headache,dizziness,nausea,the double vision varies from person to person.
Pineal cysts come in different types (most are benign cysts, but they can also be germinomas, astrocytomas, teratomas, etc.) These different types of pineal "cysts" have different findings on imaging.  Benign cysts have the imaging characteristics of fluid (dark on T1/Flair) images, while tumors of various types found in the pineal region show contrast enhancement, dystrophic calcifications, and/or hemmorhage.  I would recommend that you speak to your neurologist about these particular imaging characteristics and if the cysts has concerning finding, you may need to have the cyst removed.

   In addition to different types of cysts, there are also symptomatic(problems) and non-symptomatic(no-problems) cysts. The most common symptom is headaches, which can be migraine headaches (or migraine varients such as hemicrania continua) or new persistent daily headaches. Other symptoms include, limitation of vertical gaze (Parinauds syndrome) and hydrocephalus (build up of pressure in the brain). If you have signs of hydrocephalus (your neurologist will know) then endoscopic removal of the cyst is the treatment of choice.  With local mass effect (causing eye problems) open surgery may or may not be warrented.  If your only symptom from the cyst is headache, medications to treat the headaches are generally the best first approach.I would also recommend that you see an ophthamologist to evaluate your visual fields, any limitation in your up gaze, or swelling behind your eyes. I hope this has been helpful.
Goodluck.
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Avatar_f_tn
Bonnie,
Does your daughter have any other symptoms.  Our daughter is 27 yrs old now, at age 9 she was having problems that begin with excessive thirst, excessive urination.  She underwent tests (lab) and then MRIs with and without contrast.  She was finally diagnosed as having a supracellular germinoma between the pitutary and hypothalmus.  The neurosurgeon that she was referred to wanted to wait 6 months to do anything.  I told him we were getting a second opinion which we did and the new neuro doc and his boss recommended surgery, really ASAP because they along with me and my husband had already decided that without surgery we could not be sure whether the tumor was benign or malignant which it was malignant.  The doctor told us the morning of surgery that he had been studying the latest MRI and he was pretty sure the tumor was malignant before he even went into surgery.  This tumor was only the size of a pea, but he was able to remove as much as possible and then she underwent 29 radiation treatments, as of this day no sign of this type of malignancy has returned, thank God.  We were told that these type of tumors can affect the optic nerve and other stuff.  For our daughter it has affected all of her hormones.  If you have any other questions that maybe I can help answer please let me know, you can send me a message via this website or my regular email at ***@****.  I wish you and your daughter the best, I've been there and I know what it is like to watch and wait.

Diane
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Avatar_dr_f_tn
Hi,

Pineal cysts are benign and are usually asymptomatic.They may undergo degeneration and develop intracystic hemorrhage,accumulation of cyst fluid,enlarge and cause mass effects. By mass effect this means that,an enlarged cyst may compress nearby structures and cause problems with vision.It may block cerbrospinal fluid flow and cause hydrocephalus which  increases intracranial pressure and lead to headaches.

If the cysts show growth in successive MRI's and the symptoms progress, surgery is indicated.

Continue ff up with the neurologist for this warrants close supervision.

I hope this helps.
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