Dr. Saranya Balakrishnan, B18597 Dr.Maneesha Mohan Bellala, Dr. Mahesh Kumar
A 60 year old euglycemic, non-hypertensive male patient presented with headache and blurring of vision both eyes since 1day.On examination patient had unsteady gait ,vertical gaze palsy with intact doll’s eye movement, collier lid retraction sign, light near dissociation ,suggestive of Pretectal syndrome. MRI&MRV brain revealed haemorrhagic lesion in left half of midbrain along the superior colliculi with intraventricular extension. Vertical gaze palsy can be present as upgaze palsy , combined upgaze and downgaze palsy or pure downgaze palsy. Combined upgaze and downgaze palsy lesions involve the riMLF or the interstitial nucleus of Cajal, and are most frequently bilateral. In our case a UNILATERAL lesion in the midbrain paralyzed both upward and downward gaze and hence its rarity.