A full-term newborn girl presenting at birth with macrocephaly and a large pineal region hemorrhagic cyst without neurologic deficit is reported from the University of Miami Miller School of Medicine, Florida. A CT scan showed the pineal region cyst without mass effect or hydrocephalus. No evidence of vasculopathy was detected. MR imaging at 5 weeks showed mild ventriculomegaly and slight decrease in size of the cyst. MR angiography showed normal vascular anatomy. At 4 months, the neurologic exam and head circumference were normal. MR images showed complete resolution of the cyst and stable, mild ventriculomegaly. At 8 months follow-up, the MR was unchanged and the neurologic exam and head circumference remained normal. 
COMMENT. Small benign glial cysts of the pineal region are reported in 25-41% of autopsy studies and in 1.5-4.3% of brain MRs (Fain JS et al. 1994). Close observation and serial imaging are advised in nonprogressive pineal region cysts in infants.