Abstract
Pineal cysts (PCs) are common findings on (Magnetic resonance Imaging) MRI, often incidental in females and asymptomatic throughout life. Rare complications, like pineal apoplexy with acute hydrocephalus, require differential diagnosis and urgent intervention. We report a 19-year-old male with a progressive headache and visual decline. MRI showed a 2.3 cm pineal cyst with hemorrhagic features (apoplexy) causing hydrocephalus. He underwent endoscopic third ventriculostomy and microsurgical resection, both successful. Postoperatively, symptoms resolved completely. Though often benign, complicated PCs can be life-threatening. This case highlights their management, aiding understanding of etiologies, differential diagnoses, and treatments, enhancing medical knowledge.