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May 26, 2020; 94 (21) Resident & Fellow Section

Teaching Video NeuroImages: Convergence retraction nystagmus due to compressive lesion of the dorsal midbrain

View ORCID ProfileEdward Margolin, Seema Emami
First published May 4, 2020, DOI: https://doi.org/10.1212/WNL.0000000000009481
Edward Margolin
From the Department of Ophthalmology and Vision Sciences, University of Toronto, Canada.
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  • ORCID record for Edward Margolin
Seema Emami
From the Department of Ophthalmology and Vision Sciences, University of Toronto, Canada.
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Teaching Video NeuroImages: Convergence retraction nystagmus due to compressive lesion of the dorsal midbrain
Edward Margolin, Seema Emami
Neurology May 2020, 94 (21) e2285-e2286; DOI: 10.1212/WNL.0000000000009481

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A 28-year-old man had experienced binocular diplopia for the last 2 months. Around the same time, he noticed mostly nocturnal polyuria and polydipsia and eventually was diagnosed with diabetes insipidus. Extraocular motility testing demonstrated jerky convergence movements on an attempted upgaze and mild lid retraction (video 1). Urgent MRI of the brain revealed a large mass in the dorsal midbrain region, which was also compressing the hypothalamus (figure). The lesion was biopsied and a diagnosis of primary intracranial germinoma arising from pineal tissue was made. Treatment with low-dose radiotherapy commenced. Characteristic clinical features of convergence retraction nystagmus in this case allowed rapid localization of the lesion, its diagnosis, and eventually treatment.1

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Figure Sagittal T1 postcontrast MRI demonstrates large mass compressing dorsal midbrain

Video 1

Extraocular motility

A classic example of convergence retraction nystagmus that represents co-contraction of bilateral medial recti in an attempt to look up producing characteristic jerky convergence movements on attempted upgaze.Download Supplementary Video 1 via http://dx.doi.org/10.1212/009481_Video_1

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No targeted funding reported.

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The authors report no relevant disclosures. Go to Neurology.org/N for full disclosures.

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  • Teaching slides links.lww.com/WNL/B88

  • © 2020 American Academy of Neurology

Reference

  1. 1.↵
    1. Shields M,
    2. Sinkar S,
    3. Chan W,
    4. Crompton J
    . Parinaud syndrome: a 25-year (1991-2016) review of 40 consecutive adult cases. Acta Ophthalmol 2017;95:e792–e793.
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  • Reader response: Teaching Video NeuroImages: Convergence retraction nystagmus due to compressive lesion of the dorsal midbrain
    • Gabor M. Halmagyi, neurologist, Royal Prince Alfred Hospital (Sydney, Australia)
    Submitted August 02, 2020
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