Dorsal midbrain syndrome secondary to pineal gland tumours: case series and review on manifestations, management and outcome

Abstract

Dorsal midbrain syndrome or Parinaud syndrome is a supranuclear brainstem syndrome involving the vertical gaze centre. These are case series with three patients who were diagnosed with dorsal midbrain syndrome secondary to pineal gland tumours. The prognosis varied depending on tumour types, age of presentation and treatment received. All of them were presented with life-threatening obstructive hydrocephalus. Our first patient was successfully treated with emergency surgery followed by radiotherapy. He regained normal visual acuity and full recovery of his ocular movement. Second and third patients had undergone surgery for raised intracranial pressure. Both had an inoperable pineal gland tumour. As for our second patient, we detected a worsening of vertical gaze during his four years follow-up. However, his bilateral good visual acuity was preserved. The third patient passed away as a result of uncontrolled enlarging tumour. We also briefly reviewed the clinical presentation, diagnosis, and therapeutic approach of the three patients. One of the caveats is that urgent radiological study is crucial to differentiate the tumour type via the pathognomonic features and to delineate the tumour extension. The preferable treatment options vary among each tumour type. A multidisciplinary approach is crucial in early detection, in addition to treatment initiation and long term follow up to achieve a better outcome.

Keywords

• Dorsal midbrain syndrome
• Parinaud syndrome
• Pineal gland tumour