Parinaud Syndrome and Obstructive Hydrocephalus as Initial Manifestations of an AFP-Secreting Pineal Region Germ Cell Tumor: A Case Report

Authors

  • Nishchal Soti Tribhuvan University Teaching Hospital, Kathmandu, Nepal
  • Priyesh Shrestha Tribhuvan University Teaching Hospital, Kathmandu, Nepal
  • Bibek Shrestha Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
  • Ramesh Rokaya Tribhuvan University, Institute of Medicine, Kathmandu, Nepal

DOI:

https://doi.org/10.3126/njr.v15i2.95812

Keywords:

alpha-Fetoproteins, Ocular Motility Disorders, Ventriculostomy

Abstract

A 14-year-old male presented with Parinaud syndrome, obstructive hydrocephalus, and markedly elevated serum AFP (272 ng/mL) and β-hCG (317 mIU/mL), suggesting a non-germinomatous germ cell tumor (NGGCT) of the pineal region. MRI confirmed a pineal mass with pituitary stalk involvement. Endoscopic third ventriculostomy (ETV) relieved hydrocephalus and enabled CSF tumor marker sampling. Four cycles of CE/IE chemotherapy achieved complete biochemical remission with significant neurological recovery. This case highlights the neuro-ophthalmic clues to early pineal GCT diagnosis and the effectiveness of ETV combined with chemotherapy.

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Author Biographies

Nishchal Soti, Tribhuvan University Teaching Hospital, Kathmandu, Nepal

Department of Neurosurgery

Priyesh Shrestha, Tribhuvan University Teaching Hospital, Kathmandu, Nepal

Department of Radiology

Bibek Shrestha, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal

Maharajgunj Medical Campus

Ramesh Rokaya, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal

Maharajgunj Medical Campus

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Published

2026-04-10

How to Cite

Soti, N., Shrestha, P., Shrestha, B., & Rokaya, R. (2026). Parinaud Syndrome and Obstructive Hydrocephalus as Initial Manifestations of an AFP-Secreting Pineal Region Germ Cell Tumor: A Case Report. Nepalese Journal of Radiology, 15(2), 61–64. https://doi.org/10.3126/njr.v15i2.95812

Issue

Vol. 15 No. 2 (2026)

Section

Case Reports

License

Copyright (c) 2026 Nepalese Journal of Radiology

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