Abstract | December 16, 2022

Facilitated Discovery of Pineal Mass by Lumbar Puncture

Presenting Author: Jeffrey Hudgens, MD, Emergency Medicine Resident PGY3, Emergency medicine, Magnolia Regional Hospital, Corinth, MS

Coauthors: Rick Carlton, MD, Program Director Emergency Medicine, Magnolia Regional Hospital

Learning Objectives

  1. List the differential diagnosis of unilateral papilledema.
  2. Appreciate the need for reimaging when patients’ complaints change and are unexplained.

A 43-year-old man with a 2-week history of headache and blurred vision presented to his ophthalmologist because of the latter complaint. He was noted to have unilateral papilledema and an MRI Brain revealed ventriculomegaly thought to be due to normal pressure hydrocephalus. A lumbar puncture (LP) was subsequently performed with an opening pressure of 20 cm H2O and 15 cc of CSF was removed. He developed a classic post-LP headache the next day that was successfully treated with a blood patch.

 

Several hours later, however, he began having a different headache from the post-LP one earlier in the day. His physical exam was normal and unchanged; including a neurological exam which revealed him to be alert and oriented X3, intact cranial nerves, normal gait and no motor/sensory deficits with normal reflexes. With a very recent MRI Brain, a CT Head was obtained and demonstrated a new 1.4 cm pineal mass that was not seen on the MRI.

 

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