Binocular Vertical Diplopia as an Initial Manifestation of Pineal Germinoma

Abstract

A 33-year-old man presented with binocular vertical diplopia for a month. Neurological examination showed bilateral skew deviation, upward gaze palsy and light-near dissociation with neither lid retraction nor convergence retraction nystagmus. Cerebral magnetic resonance imaging and pathological examination revealed a pineal gland germinoma. He was treated with irradiation, 3,000 centiGray (cGy) to the craniospinal region and 5,400 cGy to the tumor site, with complete tumor regression. Neuro-imaging is warranted to exclude pineal germinoma in patients presenting with binocular vertical diplopia from skew deviation.

KEYWORDS::

• Diplopia
• Dorsal midbrain syndrome
• Ophthalmoplegia
• Pineal germinoma
• Skew deviation

ACKNOWLEDGMENTS

We wish to acknowledge the support of the Khon Kaen University Publication Clinic, Research and Technology Transfer Affairs, for their assistance in English translation of the manuscript.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.