Synonyms:
Sylvian acqueduct syndrome a.k.a. Koeber-Salus-Elschnig syndrome
Diagnosis:
This syndrome is a clinical diagnosis. The underlying cause is determined by investigations and clinical correlation.
Clinical features:
Slightly dilated fixed pupils (i.e. no light reflex), light-near dissociation, upward gaze palsy.
Lid retraction (Collier’s sign)
Convergence-retraction nystagmus (especially on attempted up gaze)
Investigations to consider:
MRI:
- Lesion in tectum/superior colliculus
- E.g. pineal tumors, extending thalamic tumors, gliomas, Wernicke encephalopathy, MS plaque, tuberculoma
RPR: neurosyphilis
Consider investigations for MS