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PHOTO ESSAY
Year : 2022  |  Volume : 60  |  Issue : 1  |  Page : 106-107

Pineal gland arteriovenous malformation with optic neuropathy


1 Department of Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
2 Department of Uvea, Ocular Pathology and Neuro-Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India

Date of Submission13-Sep-2021
Date of Acceptance26-Oct-2021
Date of Web Publication22-Mar-2022

Correspondence Address:
Dr. Nitu Kumari
Sri Sankaradeva Nethralaya, 96, Basistha Road, Guwahati - 781 028, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_141_21

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  Abstract 


We present the case of pineal gland arteriovenous malformation (AVM) with optic neuropathy in a 29-year-old male who presented to our hospital with diminished vision in both eyes associated with headache, dizziness, and generalized weakness for 3 years. Visual acuity was counting finger at 3 m in the right eye and counting finger close to the face in the left eye. Posterior segment examination showed papilloedema. Magnetic resonance imaging of the brain and orbit with angiography revealed AVM in the pineal gland area which was compressing over the cerebral aqueduct and floor of the third ventricle causing ventricular dilation.

Keywords: Arteriovenous malformation, obstructive hydrocephalus, optic neuropathy


How to cite this article:
Kumari N, Das D, Mahato DK. Pineal gland arteriovenous malformation with optic neuropathy. TNOA J Ophthalmic Sci Res 2022;60:106-7

How to cite this URL:
Kumari N, Das D, Mahato DK. Pineal gland arteriovenous malformation with optic neuropathy. TNOA J Ophthalmic Sci Res [serial online] 2022 [cited 2022 Jun 29];60:106-7. Available from: https://www.tnoajosr.com/text.asp?2022/60/1/106/340352




  Introduction Top


Arteriovenous malformations (AVMs) are the most common form of intracranial vascular malformations in adults. It is thought to be static congenital lesions; still, a subset may possess dynamic pathophysiological capabilities of growth, regression or other morphological changes with time.[1] We present a case of pineal gland AVM with optic neuropathy in an young male.


  Case Report Top


A 29-year-old male presented with diminished vision in both eyes (OU) which was associated with vertigo, dizziness, headache, and generalized weakness for 3 years. On examination, protrusion of posterior fontanelle was noted. Visual acuity in his right eye was counting finger at 3 m and left eye was counting finger close to face, with exotropia noted in OU, more pronounced on the left side. On slit-lamp biomicroscopy, anterior segment was within normal limits and posterior segment examination with 90 Diopter lens showed papilloedema [Figure 1]. Provisional diagnosis of suspected intracranial lesion with optic neuropathy was made. Magnetic resonance imaging of the brain and orbit with magnetic resonance angiography revealed a large vascular malformation in the pineal gland area extending into the cerebral aqueduct and roof of fourth ventricle with multiple feeders vessels predominantly from the posterior cerebral arteries [Figure 2]. The lesion was also compressing the cerebral aqueduct and floor of the third ventricle causing mild upstream ventricular dilatation suggestive of obstructive hydrocephalus [Figure 3]. The patient was immediately referred to neurosurgeon for further management.
Figure 1: (a and b) Papilloedema in the right and left eye

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Figure 2: (a) Axial T1-weighted magnetic resonance imaging scan depicting arteriovenous malformation, (b) magnetic resonance angiography revealing arteriovenous malformation and dilated vessels

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Figure 3: (a) Sagittal T2-weighted magnetic resonance imaging (MRI) scan showing dilated ventricles and obstruction of cerebral aqueduct causing obstructive hydrocephalus, (b) axial T1-weighted MRI scan showing ventricular dilation

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  Discussion Top


AVMs have been defined as congenital high-flow shunts between arteries and veins with a central tangled nidus devoid of capillaries.[1] Hydrocephalus is least encountered neurologic problem in patients with un-ruptured AVMs.[2] Focal neurological deficit, seizure, and headache are the most common symptoms.[3] The treatment of AVM mainly depends mostly on its location which include observation, surgical removal, stereotactic radiosurgery, endovascular therapy, or a combination of these modalities.[4]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initial will not be published and due efforts will be made to conceal their identity.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Tucker A, Tamura Y, Hanabusa K, Miyake H, Tsuji M, Ukita T, et al. Endoscopic third ventriculostomy for hydrocephalus due to unruptured pineal AVM: Case report and review of the literature. J Neurol Surg A Cent Eur Neurosurg 2013;74 Suppl 1:e45-9.  Back to cited text no. 1
    
2.
Geibprasert S, Pereira V, Krings T, Jiarakongmun P, Lasjaunias P, Pongpech S. Hydrocephalus in unruptured brain arteriovenous malformations: Pathomechanical considerations, therapeutic implications, and clinical course. J Neurosurg 2009;110:500-7.  Back to cited text no. 2
    
3.
Ding D, Starke RM, Kano H, Mathieu D, Huang PP, Feliciano C, et al. International multicenter cohort study of pediatric brain arteriovenous malformations. Part 1: Predictors of hemorrhagic presentation. J Neurosurg Pediatr 2017;19:127-35.  Back to cited text no. 3
    
4.
Weil AG, Obaid S, Berthelet F, McLaughlin N, Bojanowski MW. Arteriovenous malformation of the pineal gland. Acta Neurochir (Wien) 2011;154:65-6.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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