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Skarbez, Kathryn; Fanciullo, Lisa

Metastatic Melanoma from Unknown Primary Presenting as Dorsal Midbrain Syndrome

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Dorsal midbrain syndrome, which is characterized by upgaze paralysis, light-near dissociated pupils, eyelid retraction, and convergence retraction nystagmus, can be caused by compression, ischemia, inflammation, or injury to the dorsal midbrain. Although brain metastases are common in certain cancers, including melanoma, only 3 to 5% occur in the brain stem. We present a case of metastatic melanoma from an unknown primary that initially presented as dorsal midbrain syndrome.


Case Report. 

After a prodrome of intermittent nonspecific visual symptoms, a 60-year-old male veteran presented with bilateral upgaze paralysis and convergence retraction nystagmus. A single hemorrhagic lesion in the midbrain was causative. An inguinal mass with associated lymphadenopathy was subsequently discovered, and the biopsy from this site revealed malignant melanoma. A primary lesion was never found. The patient underwent surgical resection of the groin lesion and stereotactic radiosurgery for the midbrain metastasis but passed away 6 months after his initial presentation.



The presentation of bilateral vertical gaze paralysis, especially in the company of convergence retraction nystagmus, light-near dissociated pupils, or eyelid retraction, should raise concern for midbrain pathology. Although metastases to the midbrain are rare, they carry a grave prognosis, especially if melanoma is the primary malignancy, and most treatment options are considered palliative.


I haven't actually used the optometrist side, so my review is limited to the vision therapy offered.  This office was recommended by my occupational therapist for the treatment of my double vision following a stroke.

Claire A.

Love this location. I had a brain injury accident from day one one. All the team make you feel you still important and hope in the horizon after when the medical system fell you miserably. Dr. Ikeda very professional and very understanding about your issue. Two tombs up.

Jim K.

My husband and I were immediately impressed with Dr Ikeda. I was hit by a car while cycling which caused broken bones and three brain injuries. The brain injuries caused double vision. Dr. Ikeda examined my eyes and got me started on vision therapy with his occupational therapist who specializes in vision therapy.  She (Chris) is absolutely great.  I am impressed with the array of tools used to help recover my binocular vision.  I am doing things I never thought were possible (balance boards etc).  Chris pushes me and keeps me motivated. I really enjoy my sessions with her.  The office staff is always friendly and they have a wonderful appointment reminder tool that makes it easy to keep my calendar up to date. I am happy the rehab center at Little Co. of Mary recommended them!!

Teresa S.

The Vision Therapy is handled in a separate office through a different door from the shared waiting room. Chris, the vision therapist, has a wide and varied assortment of tools, equipment and resources to best evaluate and treat most vision issues. After just a few visits, my double vision became easier to control, using exercises developed during the therapy process. It was time well-spent.

Joe M.

I have been coming here since I can remember. I love it here. The staff is so amazing and nice. They explain everything they gonna do and never make you feel rushed. Dr. Ikeda has always been my doctor and I would never want another one. He is the doctor for my whole family and is always asking how everyone is doing. I am also so crazy about picking out my frames and have to try so many and each person who helps me take the time and lets me try them all on. I would never want to go anywhere else! I definitely would recommend this office to anyone looking for a great eye doctor.

Kayla W.

This is not for the eye exam but for the frames selection portion. I brought my prescription from Kaiser here with my VSP insurance. The reception staff was very polite and professional.  Manny helped me to pick out frames and explain my coverage.  Very helpful and patient not like the individual at the other place I rated here on Yelp.  I was running late and he still helped me and was not bothered at all.  I am so glad I came here ..........very pleased.

Very professional staff and pleasant.

Daniel G.
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