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Pineal Region Mass

A 15-year-old boy presented with acute exacerbation of chronic headache, as well as new onset nausea, vomiting, and visual changes. Past medical history and review of systems were noncontributory. Physical examination revealed mild papilledema and paralysis of upward gaze. The patient was subsequently referred for an emergent head CT, which was initially performed without contrast but then with contrast based upon the preliminary findings, followed by an MRI of the brain with and without contrast (Fig.).