Virginia Research Day 2025

Medical Student Research Case Reports

14 Headache in a Division 1 Track & Field Thrower

Logan O’Donnell, OMS II; Colleen Bannigan, DO; Mary Mitchell, DO; Dr. Cara Rogers, DO; Kailee Semon, LAT, ATC Corresponding author: lodonnell@vt.vcom.edu

Virginia Tech Sports Medicine Department, Blacksburg, VA

previously managed effectively with osteopathic manipulative treatment (OMT) and intermittent Ibuprofen use. Physical examination at the time of presentation was unremarkable; however, given the constellation of symptoms, MRI imaging was recommended which showed a pineal cyst, revealing a thickened, partially calcified capsule and a possible small hemorrhagic component in the dependent posterior region. Neurosurgery was consulted who recommended a short course of steroids and Fioricet for symptom control with repeat MRI after steroid course and germ cell marker testing. She was also advised to abstain from vigorous physical activities until repeat imaging and symptom resolution. Patient underwent follow-up MRI with and without contrast which showed stable hemorrhagic pineal cyst. Given stable cyst appearance and improvement in symptoms, neurosurgery elected to treat this conservatively and cleared the athlete for full return to sport as long as she was asymptomatic. Patient gradually returned to throwing and is now participating without restrictions. She will undergo a follow-up MRI six months from the initial MRI to assess stability of the cyst.

Introduction: Pineal cysts are commonly found in the average healthy population, with a higher prevalence among females. Typically asymptomatic, pineal cysts are often discovered incidentally during imaging studies. When symptoms do occur, they may manifest as headaches, visual disturbances, or sleep issues, all of which can adversely affect an athlete’s performance. Intense training and hormonal fluctuations in female athletes may influence the development or symptomatology of these cysts, though research in this area is sparse. Currently, no consensus guidelines exist for the management of pineal cysts in athletes. In the general population, the management of pineal cysts remains controversial, guided by factors such as patient age, symptom severity, and cyst size. Case Presentation: A 21-year-old female athlete presented to the team physician with persistent headaches, dizziness, pre-syncopal episodes, worsening myopia, and anisocoria. She had a history of tension headaches secondary to her sport,

Discussion: This case highlights an unusual presentation of a pineal cyst and reinforces the importance of thorough assessment by medical professionals when patients present with symptoms like headaches and vision changes. Clinicians should be vigilant in these cases, as such symptoms could signify underlying structural abnormalities like pineal cysts. Additionally, this case raises questions about potential underlying causes of pineal cysts, especially in relation to hormonal fluctuations in women and the effects of intense physical activity, such as participation in Division I athletics specifically with Valsalva maneuvers such as this athlete, on the progression and symptoms of these cysts. Further research is needed to determine whether conservative symptom management with medication is sufficient for female patients with these lifestyle factors or if alternative approaches should be explored. The authors obtained informed consent from the patient for the use of her data in this report.

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