Early Dorsal Midbrain Syndrome Mimicking an Adie's Tonic Pupil.
BACKGROUND
While tonic pupils have been attributed to various diseases, including syphilis, herpes zoster, orbital trauma, temporal arteritis, endometriosis, and paraneoplastic syndromes, obstructive hydrocephalus has not been implicated.


METHODS
A 36-year-old woman visited a neurology department with a 7-day history of throbbing headache and blurred vision in both eyes. She had early dorsal midbrain syndrome mimicking an Adie's tonic pupil, and cholinergic supersensitivity was demonstrated using topical 0.125% pilocarpine. Brain MRI revealed obstructive hydrocephalus at the level of the aqueduct of Sylvius, and her symptoms resolved 4 days after surgery.


CONCLUSIONS
We report a patient with early dorsal midbrain syndrome that was initially believed to represent a tonic pupil on the basis of pharmacologic testing. The findings in our patient suggested that early dorsal midbrain syndrome mimicking an Adie's tonic pupil can be caused by obstructive hydrocephalus compressing the Edinger-Westphal nucleus.
Han
Sang Won
SW
Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
Ryu
Jung Ho
JH
Baik
Jong Sam
JS
Kim
Jeong Yeon
JY
Hwang
Yong Soon
YS
Park
Jae Hyeon
JH
Ophthalmologica. 2004 Mar-Apr;218(2):141-3
15004505
J Pediatr Ophthalmol Strabismus. 2005 May-Jun;42(3):176-9
15977871
Rev Neurol (Paris). 2005 Oct;161(10):963-6
16365626
Br J Ophthalmol. 1984 Feb;68(2):135-8
6691957