A not so incidental finding in a 12 year old with sleepiness and headaches

A 12-year-old girl presented with headaches and hypersomnolence. Her bedtime was 10 PM with a latency of 30 minutes. Reported sleeping for 12-16 hours. Upon awakening she felt sleepy and tired but this resolved as the day went on. There were no symptoms of snoring, parasomnias, hypnagogic hallucinations, cataplexy, sleep paralysis, or restless legs. Physical and neurologic exams were normal. Polysomnography was normal. Brain MRI showed a pineal cyst (Figure 1). Salivary melatonin levels (ELISA/EIA calibrated range 0.78-50 pg/ml) were collected by the parent; at home, under regular bedtime conditions.

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