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Upward Gaze

Topic: Anatomy

Created on Sunday, February 1 2009 by dr. no

Last modified on Sunday, February 1 2009.

A 72 year old man presents with a month history of progressive difficulty in upward gaze and was found on exam mid-dilated mildly reactive pupils, and convergence-retraction nystagmus. Where is the lesion?

 
        A) Lower Pons
 
        B) Thalamus
 
        C) Dominant parietal lobe
 
        D) Non-dominant parietal lobe
 
        E) Midbrain tectal region
 

 


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This question was created on February 01, 2009 by dr. no.
This question was last modified on February 01, 2009.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANSWERS AND EXPLANATIONS




A) Lower Pons

This answer is incorrect.


A lesion producing these findings occurs in the midbrain tectal region. It usually occurs by extra-axial compression on the quadrigeminal plate. These findings are consistent with Parinaud's syndrome  (See References)

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B) Thalamus

This answer is incorrect.


A lesion producing these findings occurs in the midbrain tectal region. It usually occurs by extra-axial compression on the quadrigeminal plate. These findings are consistent with Parinaud's syndrome  (See References)

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C) Dominant parietal lobe

This answer is incorrect.


A lesion producing these findings occurs in the midbrain tectal region. It usually occurs by extra-axial compression on the quadrigeminal plate. These findings are consistent with Parinaud's syndrome  (See References)

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D) Non-dominant parietal lobe

This answer is incorrect.


A lesion producing these findings occurs in the midbrain tectal region. It usually occurs by extra-axial compression on the quadrigeminal plate. These findings are consistent with Parinaud's syndrome  (See References)

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E) Midbrain tectal region

This answer is correct.


A lesion producing these findings occurs in the midbrain tectal region. It usually occurs by extra-axial compression on the quadrigeminal plate. These findings are consistent with Parinaud's syndrome  (See References)

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References:

1. Leigh, R.J., and Zee, D.S. (2006). The Neurology of Eye Movements, 4th Edition. Oxford University Press, Oxford. (ISBN:0195300904)Advertising:
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anatomy
Upward Gaze
Question ID: 020109085
Question written by dr. no. (C) FrontalCortex.com 2006-2009, all rights reserved. Created: 02/01/2009
Modified: 02/01/2009
Estimated Permutations: 120

User Comments About This Question:

1 user entries
 

rednucleus
anatomy The Pupils Feb 05, 2009 @ 05:26

Thanks for the question. Please post more.

I would suggest the use of "sluggishly" reactive pupils rather than "mildly" reactive pupils; I think the term "mild" is somewhat misleading in this Parinaud's, i.e. the pupils could not be mildly, moderately, or severely reactive.  

Regards and the very best...

Amin

 



 
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