Wong Kah-Hie, Cheng Teck-Chee, Md Pauzi Suria Hayati, Wan Abdul Halim Wan Haslina, Md Din Norshamsiah
Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS.
Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS.
Cureus. 2023 Jul 26;15(7):e42497. doi: 10.7759/cureus.42497. eCollection 2023 Jul.
Convergence-retraction nystagmus alongside behavioral changes can be rare manifestations of a potentially life-threatening midbrain lesion. After experiencing headaches for three months, a 13-year-old boy was diagnosed with depression due to exhibiting reduced speech, hypersomnia, and psychomotor slowing for three weeks. It was preceded by headache for three months. Examination revealed visual acuity of 6/6 bilaterally, convergence-retraction nystagmus worst on upgaze, limited bilateral ocular motility in upgaze, and light-near dissociation on pupil examination, all of which point towards Parinaud's syndrome. However, there was no lid retraction to suggest Collier's sign. Fundus examination revealed papilledema. Magnetic resonance imaging showed a large pineal mass extending to both thalami, dilated ventricles due to obstructive hydrocephalus, and cerebral edema. An urgent external ventricular drain was inserted, and biopsy revealed pineal gland germinoma. Chemotherapy and radiotherapy resulted in adequate tumor shrinkage. This case report highlights that subacute behavioral changes may mask a potentially life-threatening intracranial tumor, especially when associated with abnormal eye movement.
集合-退缩性眼球震颤伴行为改变可能是潜在危及生命的中脑病变的罕见表现。一名13岁男孩在经历了三个月的头痛后，因出现言语减少、嗜睡和精神运动迟缓三周而被诊断为抑郁症，在此之前有三个月的头痛病史。检查发现双眼视力均为6/6，向上注视时集合-退缩性眼球震颤最明显，向上注视时双侧眼球运动受限，瞳孔检查有光近分离，所有这些都指向帕里诺德综合征。然而，没有眼睑退缩提示科利尔征。眼底检查发现视乳头水肿。磁共振成像显示一个巨大的松果体肿块延伸至双侧丘脑，由于梗阻性脑积水导致脑室扩张，以及脑水肿。紧急插入了外部脑室引流管，活检显示为松果体生殖细胞瘤。化疗和放疗使肿瘤充分缩小。本病例报告强调，亚急性行为改变可能掩盖潜在危及生命的颅内肿瘤，尤其是当与异常眼动相关时。
