[A case of pineal germinoma presenting with severe amnesia]

Patients who have a pineal germinoma usually present with symptoms of intracranial hypertension or disturbances in vertical ocular motion but rarely present with amnesia. We recently encountered a case of pineal germinoma accompanied by severe amnesia, but not by hydrocephalus. A 32-year-old, right-handed man was admitted with severe memory disturbance which had gradually worsened in the preceding three months. On admission, he was alert and cooperative. His speech was well preserved and not fabricated. He had neither symptoms of intracranial hypertension or visual disturbance. There was no manifestation of interhemispheric disconnection symptoms. His immediate and semantic memory was preserved, however, his recent and antegrade episodic memory was severely impaired. The amnesia involved both verbal and visual modalities. He could recall only 1 out of 5 objects in 5 minutes. He was orientated to people, but not to time and place. And his motivation was severely affected. Magnetic resonance imaging (MRI) showed a heterogeneously enhanced tumor in the splenium and pineal body that extended into the bilateral ventricular trigon through major forceps and was accompanied by edema in the retrosplenial region. The bilateral crura of the fornix was obscured by the tumor. The enlarged pineal body was slightly compressing the upper colliculus but hydrocephalus was not observed. The tumor, which was partially excised through a right parietal corticotomy, had features typical of a germinoma.(ABSTRACT TRUNCATED AT 250 WORDS)