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Case Report

Transient Dorsal Midbrain Syndrome as the Initial Presentation of Multiple Sclerosis

Malloy, Kelly A. OD1*; Draper, Erin M. OD1; Maglione, Ashley Kay OD1

doi: 10.1097/OPX.0000000000001413

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.

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.

1Salus University Pennsylvania College of Optometry, Elkins Park, Pennsylvania


Submitted: November 12, 2018

Accepted: March 11, 2019

Funding/Support: None of the authors have reported funding/support.

Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest.

Author Contributions: Conceptualization: KAM, EMD, AKM; Data Curation: KAM, EMD; Formal Analysis: KAM; Investigation: KAM; Writing – Original Draft: KAM; Writing – Review & Editing: KAM, EMD, AKM.

Online date: July 17, 2019

© 2019 American Academy of Optometry