Rida Mitha
Background: The coincidence of Moyamoya along with pineal germinoma is not reported in the literature.
Case description: We report an unusual presentation of a 19-year-old young man diagnosed with pineal gland germinoma and Moyamoya syndrome. He presented with Parinaud’s syndrome, with radiological investigations (CT and MRI scans) showing pineal gland enhancing lesion causing obstructive hydrocephalus. Endoscopic third ventriculostomy along with lesion debulking yielded a diagnosis of pineal germinoma. Postoperatively he developed bilateral middle cerebral artery territory infarcts and became aphasic with left hemiparesis. Computed Tomography (CT) angiography revealed bilateral Moyamoya vasculopathy. Two months post-operatively he developed spontaneous left frontal lobe hemorrhage with intraventricular extension; emergent external ventricular drain inserted. The patient was discharged in a vegetative state.
Conclusion: Management of both these conditions pose a therapeutic challenge as chemo-radiation therapy for germinoma holds a risk of potential worsening of neurologic deficits related to Moyamoya.
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