PMC8247747_01
A 16-year-old boy who presented with headache and blurred vision. Axial (a), coronal (b), and sagittal (c) post-contrast MRI shows a 3.4 x 3 cm lesion centered in the pineal gland. Superiorly extends to bilateral cerebral peduncles up to the thalamus. Inferiorly extent to the dorsal aspect of the pons axial T2WI (d) shows dilated temporal horns of lateral ventricle and tortious optic nerve with flattened sclera in keeping with papilledema and increase intracranial pressure.
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F1
The MRI [Figure 1] showed an enhancing midline mass at the pineal region causing obstructive supratentorial hydrocephalus.
A 16-year-old boy who presented with headache and blurred vision. Axial (a) and sagittal (b) non-contrast CT scan performed 2 weeks after endoscopic third ventriculostomy shows significant reduction of the ventricular dilatation and periventricular edema. The pineal lesion shows calcifications without hemorrhagic component.
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F2
CT examination after removal of the ventricular drain is shown in Figure 2.
A 16-year-old boy who presented with headache and blurred vision. Axial (a) and sagittal (b) post-contrast T1WI performed 2 months after treatment shows significant regression the enhancing foci and a small posterior pseudomeningocele at the surgical site.
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F3
MRI was performed 2 months after the start of treatment [Figure 3] and showed significant decrease in the size of the enhancing lesion.
A 16-year boy 1 year after treatment, sagittal post-contrast T1 (a) and axial FLAIR images shows near complete resolution of the enhancing lesion in the posterior midbrain (long arrow) and reduction of the edema in the midbrain and medial thalami (thick short arrow).
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F4
MRI examination after 1 year of the treatment [Figure 4] was performed and showed further decrease in the size of the granuloma.
A 16-year-old boy presented with the left-sided weakness and unsteady gait 2 years after the initial presentation. Axial T2 (a), axial (b, c), and coronal (d) post-contrast T1 MRI images show two enhancing lesions involving the right cerebral peduncle and the thalamus with surrounding vasogenic edema and mass effect on the third ventricle.
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F5
MRI examination [Figure 5] was done and showed two new enhancing lesions at the right cerebral peduncle and right thalamus.
A 16-year-old boy 4 months after reinitiation of therapy. Axial T2 (a), FLAIR (b), post-contrast T1 (c) and sagittal post-contrast T1 (d) images show interval remarkable disappearance of previously seen enhancing foci in the midbrain and right thalamus on post-contrast study. Persistent abnormal signal intensity in the brain stem and both thalami but less evident compared to the previous study.
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F6
MRI examination performed in March 2017 [Figure 6] and December 2019 [Figure 7] showed resolution of the tuberculoma with residual gliosis.
A 16-year-old boy at 3-year follow-up after the second presentation. Axial T2 (a), FLAIR (b), post-contrast T1 (c) show residual high signal intensity in the midbrain without abnormal enhancement. Axial DWI and ACD (d, e) show no diffusion restriction. Sagittal post-contrast T1 (f) shows no residual enhancing pineal lesions.
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F7
MRI examination performed in March 2017 [Figure 6] and December 2019 [Figure 7] showed resolution of the tuberculoma with residual gliosis.