Upward gaze limitation suggests pretectal dysfunction and, particularly in adolescents, is often an ominous indication of a pineal region tumor.1 In one of our patients, however, upward gaze paresis was the outstanding early sign of Fisher's variant of Guillain-Barré syndrome, and the patient recovered uneventfully.
REPORT OF A CASE
Ten days after having had an upper respiratory tract infection, a 15-year-old boy became dizzy and noticed blurred and double vision. His symptoms remained unchanged until three days later, when nausea, vomiting, and difficulty in walking developed. Examination found complete upward gaze paralysis and horizontal nystagmus. A computed tomographic (CT) scan was normal. The patient was admitted to the local hospital.The following day, visual acuity and confrontation visual fields were normal, as were the optic fundi. The pupils were 4 mm in diameter and reacted normally to light. There was slight symmetric limitation of gaze to either side
James R. Keane, Bruce A. Finstead. Upward Gaze Paralysis as the Initial Sign of Fisher's Syndrome. Arch Neurol. 1982;39(12):781–782. doi:10.1001/archneur.1982.00510240043012