DR. GREESHMA KRISHNA REDDY

Dr. SHEETAL GIRIMALLANAVAR, DR. SEEMA CHANNABASAPPA

Abstract

55Y/F, a known case of acute on chronic kidney disease,hypothyroidism, systemic hypertension and T2DM presented for evaluation for restricted eye movements on horizontal gaze and vertical gaze.

There was partial restriction of vertical gaze in both eyes suggestive of dorsal midbrain syndrome and there was also associated horizontal gaze restriction a sign different from dorsal midbrain syndrome. Dilated fundoscopy showed grade 2 hypertensive retinopathy and no evidence of diabetic retinopathy, disc appeared normal.

MRI Brain showed well defined T1W isointense to hypointense and T2W/FLAIR heterogeneously hyperintense peripherally enhancing lesion with elevated choline peak in left side of midbrain with diffuse perilesional edema suggestive of left dorsal midbrain tuberculoma/glioma.PET CT showed focal hypermetabolic lesion in left superior collicus with surrounding edema suggestive of ?tuberculoma/?glioma.