Prompt neuroimaging is important to identify multiple sclerosis lesions in the appropriate clinical setting. However, despite a normal brain MRI finding, a diagnosis of multiple sclerosis still must be considered in cases of dorsal midbrain syndrome, even if it is transient.
The purpose of this case report is to present a patient with a transient presentation of dorsal midbrain syndrome, resolving within 1 week of initial symptoms, which was ultimately attributed to multiple sclerosis in the setting of a normal enhanced brain MRI study.
A 33-year-old man with new-onset visual complaints was found to have upgaze paresis, eyelid retraction, and pupillary light-near dissociation suggestive of dorsal midbrain syndrome. Within days, enhanced brain MRI was completed and showed a normal finding, and the clinical features of dorsal midbrain syndrome had resolved. Subsequent spine imaging and lumbar puncture lead to an ultimate diagnosis of multiple sclerosis.