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Suggest treatment for pineal cyst of 1cm

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Posted on Thu, 14 May 2015
Question: I have 1cm pineal cyst floating in fluid. My neuro says its nothing. I recently began suffering insomnia. Neuro says due to divorce stress /psych not cyst?
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Answered by Dr. Dariush Saghafi (1 hour later)
Brief Answer:
I concur with your neurologist

Detailed Answer:
Good morning. My name is Dr. Saghafi and I am a neurologist from the XXXXXXX Ohio area of the world. Pineal cysts are almost always benign and found by acccident on scans. They are generally 1 cm. or less in diameter. A small percentage of these cysts may in fact, not be benign but in order to know this for sure an MRI of the head needs to be obtained with gadolinium contrast. Having said that- radiologists can generally see unusual features of the cyst which would prompt them to suggest further more detailed studies.

Pineal cysts are seen in 3x as many women as men and typically found in the patient's early to mid 30's. They can become clinically significant if they enlarge to the point of obstructing the flow of spinal fluid. Symptoms that are particularly concerning would be headaches of a sudden onset nature which may become better by changing positions; usually upon laying down. Also, there could be difficulty with looking upward with the eyes. Otherwise, unless the patient is really complaining of something major the cyst is concerned coincidental. It's seen in 5-10% of MRI's of the head and found as surprises. Vast majority never had nor ever will have symptoms of significance.

Treatment is almost never necessary and repeat MRI's are almost never necessary unless it is obvious that the cyst is growing or has some weird features that draw attention to the radiologist or neurologist. A large percentage of these cysts (up to 75%) when discovered and followed either stay stable over time or they actually SHRINK. If the cyst is above 1cm. then, I typically ask for repeat imaging in about 12 months and if there has been growth then, I consult neurosurgery....

Bottom line is that I concur with your neurologist in that nothing really needs to be done at this point ALTHOUGH if it were me and I would consider sending you for an an MRI with contrast of the head. I would want to define the cyst a bit more and then, make a decision to follow the entity. I believe your insomnia may be due to other reasons. Hard to say if the cyst could be causing these symptoms.

If this answer satisfactorily addresses your very INTERESTING question then, I'd appreciate the favor of a HIGH STAR RATING with some written feedback.

Also, CLOSING THE QUERY on your end (if there are no further comments) will be most helpful and appreciated so that this question can be transacted and archived for further reference by colleagues as necessary.

Please keep me informed as to the outcome of your situation by writing me at: bit.ly/drdariushsaghafi

All the best.

The query has required a total of 21 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Dariush Saghafi (22 minutes later)
Also my neuro says pineal gland really has not much to do with sleep in adulthood and that really its the brain itself that controls sleep. Also, I have had over 5 neurologists look at MRI they concluse its a cyst and no need for followup. But is the pineal gland what puts us to sleep?
doctor
Answered by Dr. Dariush Saghafi (21 hours later)
Brief Answer:
Pineal gland does function during adulthood but there is a decline

Detailed Answer:
Good evening. I'd like to answer these additional questions and start by saying that in fact, the pineal gland continues to function during adulthood although there is no question that as we age the function of that gland and its relevance to sleep becomes less and less. I don't agree that the "pineal gland really has not much to do with sleep in adulthood." The secretion of melatonin during the appropriate time during the sleep/wake cycle is critical in order to help the organism stay on schedule and on target with what it needs to do.

It is true that sleep/wake cycles do have other structures in the brain that attend to it but the pineal gland is not entirely dysfunctional until such time as the gland becomes completely calcified. In 98-99% of cases a pineal cyst need not be followed frequently. The only difficulty I have with their decision on how to proceed is that in a small percentage of cases involving the pineal gland....a cyst can turn out to be malignant. Therefore, I would be ONE of perhaps 6 neurologists who would push for being absolutely sure that the cyst is the cyst and not something else that is NOT A CYST....make sense?

I would also agree that conversion from benign to cancerous state is highly unlikely and so regular imaging f/u is not necessary at all.

And so by virtue of the pineal gland secreting melatonin (most powerful SLEEP hormone secreted) we do fall asleep much more readily and efficiently than without that hormone.

If this answer satisfactorily addresses your very INTERESTING question then, I'd appreciate the favor of a HIGH STAR RATING with some written feedback.

Also, CLOSING THE QUERY on your end (if there are no further comments) will be most helpful and appreciated so that this question can be transacted and archived for further reference by colleagues as necessary.

Please keep me informed as to the outcome of your situation by writing me at: bit.ly/drdariushsaghafi

All the best.

The query has required a total of 55 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2473 Questions

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Suggest treatment for pineal cyst of 1cm

Brief Answer: I concur with your neurologist Detailed Answer: Good morning. My name is Dr. Saghafi and I am a neurologist from the XXXXXXX Ohio area of the world. Pineal cysts are almost always benign and found by acccident on scans. They are generally 1 cm. or less in diameter. A small percentage of these cysts may in fact, not be benign but in order to know this for sure an MRI of the head needs to be obtained with gadolinium contrast. Having said that- radiologists can generally see unusual features of the cyst which would prompt them to suggest further more detailed studies. Pineal cysts are seen in 3x as many women as men and typically found in the patient's early to mid 30's. They can become clinically significant if they enlarge to the point of obstructing the flow of spinal fluid. Symptoms that are particularly concerning would be headaches of a sudden onset nature which may become better by changing positions; usually upon laying down. Also, there could be difficulty with looking upward with the eyes. Otherwise, unless the patient is really complaining of something major the cyst is concerned coincidental. It's seen in 5-10% of MRI's of the head and found as surprises. Vast majority never had nor ever will have symptoms of significance. Treatment is almost never necessary and repeat MRI's are almost never necessary unless it is obvious that the cyst is growing or has some weird features that draw attention to the radiologist or neurologist. A large percentage of these cysts (up to 75%) when discovered and followed either stay stable over time or they actually SHRINK. If the cyst is above 1cm. then, I typically ask for repeat imaging in about 12 months and if there has been growth then, I consult neurosurgery.... Bottom line is that I concur with your neurologist in that nothing really needs to be done at this point ALTHOUGH if it were me and I would consider sending you for an an MRI with contrast of the head. I would want to define the cyst a bit more and then, make a decision to follow the entity. I believe your insomnia may be due to other reasons. Hard to say if the cyst could be causing these symptoms. If this answer satisfactorily addresses your very INTERESTING question then, I'd appreciate the favor of a HIGH STAR RATING with some written feedback. Also, CLOSING THE QUERY on your end (if there are no further comments) will be most helpful and appreciated so that this question can be transacted and archived for further reference by colleagues as necessary. Please keep me informed as to the outcome of your situation by writing me at: bit.ly/drdariushsaghafi All the best. The query has required a total of 21 minutes of physician specific time to read, research, and compile a return envoy to the patient.