Dorsal Midbrain Syndrome in Two Patients

C.P. is a 34yearoldwoman who had two weeks of vertical binocular diplopia and left face and arm numbness. The remainder of the neurologic review of systems was negative. On examination visual acuity, color, contrast and fields were normal. Pupils were 1-2+ reactive with minimal reaction to convergence. Upbeat nystagmus was present in primary gaze, increasing on upgaze. Up and down gaze were limited to 10% of normal. There was a 13 diopter right hypertropia. Horizontally, pursuit was saccadic and saccades were slowed. On the remainder of the examination reflexes were 3+ and a jaw jerk was present.