J Clin Neurol.  2010 Mar;6(1):38-40. 10.3988/jcn.2010.6.1.38.

Early Dorsal Midbrain Syndrome Mimicking an Adie's Tonic Pupil

• Han SW
• Ryu JH
• Baik JS
• Kim JY
• Hwang YS
• Park JH

• KMID: 2135480
• DOI: http://doi.org/10.3988/jcn.2010.6.1.38

Abstract

BACKGROUND
While tonic pupils have been attributed to various diseases, including syphilis, herpes zoster, orbital trauma, temporal arteritis, endometriosis, and paraneoplastic syndromes, obstructive hydrocephalus has not been implicated.
CASE REPORT
A 36-year-old woman visited a neurology department with a 7-day history of throbbing headache and blurred vision in both eyes. She had early dorsal midbrain syndrome mimicking an Adie's tonic pupil, and cholinergic supersensitivity was demonstrated using topical 0.125% pilocarpine. Brain MRI revealed obstructive hydrocephalus at the level of the aqueduct of Sylvius, and her symptoms resolved 4 days after surgery.
CONCLUSIONS
We report a patient with early dorsal midbrain syndrome that was initially believed to represent a tonic pupil on the basis of pharmacologic testing. The findings in our patient suggested that early dorsal midbrain syndrome mimicking an Adie's tonic pupil can be caused by obstructive hydrocephalus compressing the Edinger-Westphal nucleus.

Keyword

dorsal midbrain syndrome; cholinergic supersensitivity; Adie's tonic pupil

MeSH Terms

Adult
Brain
Cerebral Aqueduct
Endometriosis
Eye
Female
Giant Cell Arteritis
Headache
Herpes Zoster
Humans
Hydrocephalus
Mesencephalon
Neurology
Orbit
Paraneoplastic Syndromes
Pilocarpine
Syphilis
Tonic Pupil
Vision, Ocular
Pilocarpine

Figure

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  Fig. 1 Brain MRI showing before and after ventricular-peritoneal shunting. A: Brain MRI showing dilation of the third ventricle and both lateral ventricles. No flow signal void was detected at the aqueduct of Sylvius, suggesting the presence of obstructive hydrocephalus at that level. B: Brain MRI after ventricular-peritoneal shunting indicated that the ventricular dilation had improved.

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