“Eyes Tell the Tale”. Ophthalmic manifestations of traumatic midbrain contusion in a conscious patient: A case report

Abstract

Midbrain contusions are uncommon in civilian trauma and rarely present with isolated cranial nerve deficits. We present a rare case of a conscious 40-year-old male who developed bilateral ptosis, right medial rectus palsy, and left upgaze palsy following a motor vehicle accident. NCCT brain revealed multiple contusions in the midbrain, bilateral frontal, and right parietal lobes. The patient was managed conservatively. The constellation of neuro-ophthalmic signs correlated with damage to the midbrain tegmentum and dorsal structures. This case underlines the importance of careful neuro-ophthalmic examination in head injury and highlights rare presentations of traumatic midbrain injury.