Pineal Tumor： Its Neurootological, Endocrinological and Psychiatrical Study

Neoplasms of the pineal region have many unsolved problems of their origin, pathology, symptomatology and choice of treatment. We discussed 32 cases of pineal tumors treated in this hospital during past 11 years, focusing chiefly on eye signs, endocrinological problems and psychic disorders. Out of 32 cases, males are 26 and females 6 cases. Patients from 10 to 25 years of age occupy 80%. First symptoms and signs are intracranial hypertension (40%), diplopia (20%) and impairments of visual acuity (l5%). 12% of all patients began with diabetes insipidus. During the clinical course disorders of extraocular movements, diplopia and impaired conjugate eye movements were observed in 90%, intracranial hypertension in 80% and diabetes insipidus including transient one in 20%. Some cases of diplopia showed apparent third, fourth and/or sixth cranial nerve paresis due to high intracranial pressure or direct involvement of the tumor. Others were considered due to nuclear and/or supranuclear paresis of the oculomotor nerve. Signs of eye movement disorders are, 1) disorder of convergence, 2) disorder of upward gaze, 3) convergence nystagmus and 4) retractry nystagmus, occurring and disappearing by therapy in this order. Cases beginning with diabetes insipidus revealed no neurological and neuroradiological findings enough to diagnose as pineal tumor, at the time when diabetes insipidus was found. Only when, some time later (more than 6 months), eye signs and/or high intracranial pressure appear, the tumor is diagnosed. Diabetes insipidus cases with dysfunction of the anterior lobe of the pituitary gland are highly susceptible of pineal tumor and need careful study and observation. Psychic disorders concerning the pineal tumor are akinetic mutism and emotional disturbances. Is the latter focal signs or signs associated with endocrine disorder? Estimation of the clinical course of pineal tumor needs careful neurootological, endocrinological and psychiatrical studies as well as neurological, neuroradiological and c.s.f. studies.