Introduction:

Pineal cystic (PC) lesions are commonly encountered in children undergoing brain imaging. They are often a major source of consternation for both the radiologist and clinician. Their clinical spectrum is wide varying from absence of symptoms to death.

Objective:

Studying clinical and radiologic features of PC in patients followed in child neurology department of sfax.

Results:

From 2008 to 2018, 4 patients were diagnosed with pineal cysts. Sex ratio is 1. The average mean age of diagnosis is 5.75 years. All of PC were incidentally diagnosed when MRI was performed for other symptoms: cerebellar syndrome, epilepsy, psycho-moteur impairement and langage retardation. Average mean size was 8.75 mm. Two of four cysts appears hypointense on T1 and T2-weighted images with gadolinuim enhancement. One cyst appear hyperintense on T2-weighted images and the fourth showed isointensity.

Discussion and conclusion:

PC was underdiagnosed because of the non use of 3-T MRI. The majority are smaller than 15 mm. Diagnostic is always incidental because they are often asymptomatic like in our patients. When they are large, neurologic symptoms may occurs as a result of local mass effect on adjacent structures. If headache is most common symptom, oculomotor nerve paresis, Parinaud’s syndrome, hemiparesis and epilepsy may occurs. Hydrocephalus is an obvious complication in the case of compression and occlusion of the Sylvius’s aqueduct. PC apoplexia and hemorrhage are rare but dangerous being responsible of sudden death. Because they are always benign, follow-up is not required if there are no referable symptoms or excessive size.