Dorsal midbrain syndrome

    This is a video of a patient who presented with difficulty in looking up. Vision was normal in both eyes. The pupils were mid-dilated, not reacting to light but constricting to near. Horizontal and downgaze were normal but upgaze was absent. Attempted upgaze brought about a convergence retraction nystagmus. She also had convergence insufficiency. This is dorsal midbrain syndrome or pretectal or Parinaud’s syndrome. The lesion was localized to the dorsal midbrain on neuroimaging. Such a patient may present to the ophthalmologist but the management is the realm of the neurologist or the neurosurgeon.

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