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October 1976

Visuospatial Disorientation by a Mesencephalic Lesion in Man

Author Affiliations

Academic Hospital "Dijkzigt" Rotterdam, Netherlands

Arch Neurol. 1976;33(10):729. doi:10.1001/archneur.1976.00500100063019

To the Editor.—  We were particularly interested in Denny-Brown's and Fischer's article1 about the subcortical visual direction of behavior in monkeys, because their study helped explain a puzzling defect of spatial orientation in Parinaud syndrome. These cases are rare ("... of special interest that humans... have not also presented spatial disorientation....").A 42-year-old man, previously in excellent health, suddenly experienced diplopia in all directions of gaze. When he tried to walk he was unsteady and veered to the left, without vertigo. A few hours later that day he was alert and gave a clear history. There was no nuchal rigidity. Gait and Romberg sign showed consistent deviation to the left. The right pupil was slightly smaller than the left, but there were normal responses to light. Bilateral retraction of the eyelids was also present. The left eye was depressed below the horizontal in primary position, increasing on looking to the