A 61-year-old woman with a history of treated breast cancer was initially seen with morning headache and several days of increasing confusion. On physical examination, no lateralized findings were noted, but her speech was slow, and she had difficulty concentrating and retaining new information. Magnetic resonance imaging revealed an enhancing lesion in the pineal gland (Figure 1), and cerebrospinal fluid analysis disclosed malignant cells (Figure 2), indicating metastases to the pineal and leptomeninges. The patient was referred to an oncologist for treatment, as resection was thought to be unnecessary given her poor prognosis. She underwent radiochemotherapy, only to die 2 months after diagnosis.