Case Report: Transient Dorsal Midbrain Syndrome as the Initial Presentation of Multiple Sclerosis

Authors

Malloy, Kelly A. OD; Draper, Erin M. OD; Maglione, Ashley Kay OD

Case Report: Transient Dorsal Midbrain Syndrome as the Initial Presentation of Multiple Sclerosis

publication date

March 11, 2019

Abstract/Introduction

SIGNIFICANCE

Prompt neuroimaging is important to identify multiple sclerosis lesions in the appropriate clinical setting. However, despite a normal brain MRI finding, a diagnosis of multiple sclerosis still must be considered in cases of dorsal midbrain syndrome, even if it is transient.

PURPOSE

The purpose of this case report is to present a patient with a transient presentation of dorsal midbrain syndrome, resolving within 1 week of initial symptoms, which was ultimately attributed to multiple sclerosis in the setting of a normal enhanced brain MRI study.

CASE REPORT

A 33-year-old man with new-onset visual complaints was found to have upgaze paresis, eyelid retraction, and pupillary light-near dissociation suggestive of dorsal midbrain syndrome. Within days, enhanced brain MRI was completed and showed a normal finding, and the clinical features of dorsal midbrain syndrome had resolved. Subsequent spine imaging and lumbar puncture lead to an ultimate diagnosis of multiple sclerosis.

Conclusion/Results

CONCLUSIONS

There have been a few reported cases of dorsal midbrain syndrome as the presenting feature of multiple sclerosis. This case is unique because it reports a transient presentation of dorsal midbrain syndrome, documented to have resolved only days after initial presentation, which was ultimately attributed to multiple sclerosis.

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