BACKGROUND: Pineal region tumor is a rare and reportable case. Incidence rate adults is 0.025 in 10,000 hence there is no established guidelines among adults  for diagnosis and management of this case.
CASE: A case of a 20-year-old male with a two-month history of  intermittent  headache,  occipital  area  with  VAS  5/10,increasing in severity. Until two days prior to admission with severe headache VAS 9-10/10, occipital, and nonradiating.Patient  noted  episodes  of  projectile  vomiting  hence,admitted. Patient presented with non-lateralizing symptoms but  noted  papilledema  and  parinaud  syndrome.Cranial  MRI with contrast revealed a 2.5cm pineal gland tumor with obstructive  hydrocephalus.  Serum  AFP  (alpha-fetoprotein  )  and  beta-HCG  (beta subunit of human chorionic gonadotropin) were requested and revealed elevated levels.The patient underwent endoscopic third ventriculostomy but no biopsy was done due to high risk of bleeding. Patient underwent series of radiotherapy and was advised to undergo chemotherapy but patient refused. Patient had improved upward gaze but with residuals, no recurrence of headache or vomiting, had normalization of the serum tumor markers but noted increase in size of the tumor despite radiotherapy.
CONCLUSION: Case  reports  of  pineal  region  tumors  will  help doctors  in  the  primary  hospitals  diagnose  such  cases  and differentiate it from benign causes of headache. This will aid in early referral to specialists and early intervention.

Human ; Male ; Adult ; Pinealoma ; Alpha-fetoproteins ; Chorionic Gonadotropin, Beta Subunit, Human ; Ventriculostomy ; Chorionic Gonadotropin ; Biomarkers, Tumor ; Papilledema ; Hydrocephalus ; Headache ; Vomiting ; Ocular Motility Disorders

Intracranial epidural abscess is a rare occurrence due the fact that the epidural space is tightly adherent to the overlying cranial vault, thus making it difficult for microorganisms to enter this potential space. Of the occasional reported cases of intracranial epidural abscess, most occurred in the adults, and is exceedingly rare in children less than 12 years. The mainstay of treatment in these reported cases I were combination of surgery and prolonged antibiotic coverage. This is a case of a 5 month old baby girl who was referred to the Neurology Service due to 5 day history of fever and irritability. The Patient was initially brought to hospital where she was managed with paracetamol and cotrimoxazole, which afforded no relief. No laboratory work up was requested. Due to persistence of fever, the patient was brought to a pediatrician where an unrecalled antibiotic was prescribed. On follow up, nuchal rigidity as well as bulging of anterior fontanel were noted. Hence, patient was referred to our Institution where she was subsequently admitted. On examination, there was fullness of the anterior fontanelle. The rest of the physical, as well as the dermatologic findings were unremarkable. The neurologic findings were likewise normal except for the presence of meningeal irritation. The initial impression was bacterial meningitis for which patient was started on penicillin. The CSF examination was normal with no growth on culture media. The blood culture, on the other hand, showed heavy growth of Staphylococcus aureus. A cranial ultrasound was done which revealed a 2x5 an cystic mass over the right fronto-parietal area.A cranial CT scan was consequently requested which showed a heterogeneously enhancing cystic mass over the right frontoparietal convexity which was lentiform in shape with intense enhancement of the rim. With these findings, an intracranial epidural abscess was entertained. She was started on oxacillin and was referred to the neurosurgery service for possible drainage. The patient was just managed medically after the parents declined the surgical intervention In the ward, the patient remained afebrile and was stable for the rest of the hospital stay. A repeat CT scan was done after three weeks which showed markedly decrease in size of the abscess. The patient was discharged improved after 6 weeks with no neurologic sequelae.
Female ; Infant ; Infant Newborn ; Epidural Abscess ; Bacterial Infections And Mycoses ; Bacterial Infections ; Central Nervous System Bacterial Infections ; Therapeutics ; Therapy