Benedikt syndrome (tegmental syndrome)   136

General: Lesion of the inferior nucleus tuber with obstruction of the third nerve; arteriosclerotic occlusion of branches of the basilar artery, trauma and hemorrhages in the midbrain, and neoplasm most common causes.

Ocular: Homolateral paralysis of cranial nerve III (oculomotor); involves associated movements of convergence, elevation, and depression of the eyes; loss of reflex to light and accommodation.

Clinical: Unilateral hyperkinesis; contralateral hemiparesis, coarse tremor of upper extremity (greatly increased during movement), hemihypoesthesia, and absent deep sensibility; ipsilateral ataxia. There is at least one reported case of an HIV-positive patient with Benedikt syndrome who had elevated immunoglobulin G (IgG) toxoplasma IgG titers.

Antworth MV, Beck RW Third nerve palsy as a presenting sign of acquired immune deficiency syndrome. J Clin Neuro-Ophthalmol 1987; 7: 125-l28.

Benedikt M. Tremblement Avec Paralysie Croisee du Monteur Oculaire Commune. Bull Med (Paris) 1889; 3:547.

Magalini SI, Scrascia E. Dictionary of Medical Syndromes, 2nd ed. Philadelphia: JB Lippincott, 1981.

Miller NR, ed. Walsh and Hoyt’s Clinical Neuro-Ophthalmology, vol. 5, part 2. 4th ed. Baltimore: Williams & Wilkins, 1995:3535.

Waltman SR. Ocular signs in mid-brain disease. In: Goy AJ, Burde RM, eds. Clinical Concepts in Neuro-Ophthalmology. Int Ophthalmol Clin 1967; 7:807.