1. Indicate the level of the neurologic lesion in this case as precisely as possible and the structures involved by the pathologic process.
| Signs
or Symptoms Impaired vertical upgaze eye movements Light-near dissociation of pupillary reflexes Diplopia in vertical upgaze |
Site
of
Lesion Pretectal vertical gaze center, posterior commissure Pretectal area and nuclei Posterior commissure, oculomotor nuclei |
2. The findings in this case (difficulty with vertical upgaze eye movements, especially with saccadic movements, impaired pupillary light reflexes with intact accommodation [“light-near dissociation”], diplopia in vertical gaze) represent a classic neurologic syndrome. What is the name of that syndrome? A lesion of or damage to what specific area(s) of the brain classically causes this syndrome?
3. What is the significance and possible cause of the patient’s recent onset of bursting headaches aggravated by coughing and straining? Does the patient’s papilledema relate to this process?
4. If the pathologic process in this case were a tumor or mass lesion, where would it be located, from what structure would it be originating, and by what mechanism could it be producing headache and papilledema?