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Dorsal midbrain syndrome

Clinical and oculographic findings

Department of Neurology (Drs. Baloh and Furman) and the Department of Ophthalmology (Dr. Yee), UCLA School of Medicine, Los Angeles, CA.

We report clinical and oculographic findings in seven patients with the dorsal midbrain syndrome (Parinaud's syndrome). All presented with limited upward voluntary gaze and convergence nystagmus with attempted upward voluntary gaze. Quantitative analysis of vertical eye movements documented characteristic abnormalities of saccades with relative preservation of reflex eye movements (ie, vestibular, optokinetic, and visual-vestibular). Vertical saccade velocity was only slightly decreased in five patients with tumors, indicating that the vertical burst neurons in the mesencephalic reticular formation and their efferent pathways to the oculomotor neurons were minimally damaged. On the other hand, two patients with probable brainstem encephalitis exhibited marked slowing of vertical saccades, indicating that the burst neurons, or their efferent pathways to the oculomotor neurons, were severely damaged.

Address correspondence and reprint requests to Dr. Baloh, Department of Neurology, Reed Neurological Research Center, UCLA School of Medicine, Los Angeles, CA 90024.

Supported by NIH grants NS 09823 and EY 04556 (Dr. Baloh); by NIH grant NS 00764 (Dr. Furman); and NIH grant EY 03737 and Dolly Green Scholar Award-Research to Prevent Blindness, Inc (Dr. Yee).

Accepted for publication April 24, 1984

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