Dorsal midbrain syndrome (DMS) is a supranuclear palsy of vertical gaze characterized by conjugate upgaze palsy, light-near dissociation, convergence-retraction nystagmus, lid retraction, and skew deviation. Majority of cases are due to primary midbrain lesions such as strokes or neoplasms, or due to pineal gland tumors compressing the said area. Presented here is the case of a 57-year-old male who came in with a chief complaint of diplopia and the typical signs of DMS. Cranial tomography scan revealed a parenchymal hemorrhage at the left thalamocapsuloganglionic region, a rarely reported site of a primary lesion causing DMS. In this case, the syndrome may have been a consequence of the mass effects and perilesional edema associated with the thalamocapsuloganglionic hemorrhage, or may have been due to disruption of supranuclear inputs to the dorsal mibdrain. This case provides further evidence that DMS may arise from lesions without obvious involvement of the said region. This case also highlights the importance of a thorough physical examination to elicit the findings associated with DMS, and the need to correlate these with a keen analysis of diagnostic test results.
Parinaud syndrome ; conjugate gaze spasm ; convergence insufficiency ; skew deviation

Convergence insufficiency is a common binocular vision disorder. It has been reported that the frequency of this anomaly has reached as high as 6% among school children and young adults and may affect their quality of life and near work performance. One of the treatment modalities is the Dot Card therapy. However, there is scarce research report on the effectiveness of the Dot Card therapy. Hence, this study was conducted to compare the effectiveness of the therapy given to convergence insufficiency patients among young adults. A total of 33 university students (age range=22.55±1.66 years) with convergence insufficiency problems participated in this study. Convergence insufficiency symptoms based on the Convergence Insufficiency Symptom Survey (CISS) and binocular vision components such as near point of convergence, fusional vergence and phoria were measured before and after the Dot Card therapy was given to each participant. All participants were reviewed after 2 weeks and 4 weeks. The results indicated that participants demonstrated statistically and clinically significant changes and improvement in symptom from CISS score (22.30 to 15.30, p<0.001), NPC (11.08 cm to 6.50 cm, p<0.001) and PFV at near (13.82Δ to 18.36Δ, p=0.035) at the end of 4-week visit. Participants’ near phoria were improved (2.12 exo to 1.79 exo, p=0.369) even though it is not statistically and clinically significant. The convergence insufficiency patients have achieved significant improvements in symptoms and near point of convergence both statistically and clinically, within one month of the Dot Card therapy treatment.
convergence insufficiency ; Dot Card ; vision therapy ; effectiveness ; young adults