Parinaud's and Nuclear Oculomotor Nerve Syndromes in a Patient with Mesencephalic Hematoma

Abstract

Primary hematomas of the mesencephalon are extremely rare. We report in this article a case of Parinaud's syndrome and nuclear oculomotor nerve palsy due to a mesencephalic hematoma, as a rare cause. Neuro-ophthalmological examination revealed incomplete bilateral ptosis. All vertical movements were restricted; she could not elevate or depress either eye. She could not carry out convergence and Bell's phenomenon was negative. Both pupils were slightly dilated and were unreactive to direct and consensual light stimulation. Magnetic resonance imaging (MRI) revealed hematoma of the mesencephalon. The Ppatient was followed conservatively and after six months her neuro-ophthalmological examination improved almost completely. A repeat cranial MRI revealed resolution of the midbrain hematoma.

KEYWORDS:

• Mesencephalic hematoma
• oculomotor nerve palsy
• Parinaud's syndrome