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Snapshot
  • A 5-year-old boy is brought to his pediatriatrician for diplopia. His mother noticed he is unable to look up at her. His symptoms have been associated with episodes of nausea and he has complained of a headache. Physical exam is notable for an upward gaze palsy and a pupillary light-near dissociation. An MRI of the brain demonstrates a pinealoma.
Introduction
  • Definition
    • neuro/optical symptoms caused by pressure on the rostral or upper midbrain (pretectal area)
      • results in a supranuclear vertical gaze palsy
  • Etiology
    • pinealoma
    • stroke
    • hydrocephalus
Presentation
  • Symptoms
    • diplopia
    • upper eyelid retraction
  • Physical exam
    • upward gaze palsy
    • pupillary light-near dissociation
    • convergence-retraction nystagmus
Imaging
  • MRI
    • indication
      • used to identify the what's compressing the pretectal area
Treatment
  • Treat underlying cause if present
  • Surgical correction
    • inferior rectus recession
    • superior rectus resection
    • superior transposition of medial and lateral rectus muscles
  • Visual training and tracking exercises

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