An Enhancing Bladder Metastasis Involving the Tectum of the Midbrain

Magnetic resonance image of an enhancing bladder metastasis involving the tectum of the midbrain of a 56-year-old man who developed double vision resulting from skew deviation and divergence insufficiency. He also had a left-sided relative afferent pupillary defect measuring 1.4 log units but showed normal visual acuity, color vision, and visual fields when tested using automated perimetry.Ellis CJK: Afferent pupillary defect in pineal region tumour. J Neurol Neurosurg Psychiatry 1984;47:739-741: http://www.ncbi.nlm.nih.gov/pubmed/6747651; Johnson RE, Bell RA: Relative afferent pupillary defect in a lesion of the pretectal afferent pupillary pathway. Can J Ophthalmol 1987;122:282-284: http://www.ncbi.nlm.nih.gov/pubmed?term=2822213; Forman S, Behrens MM, Odel JG, et al: Relative afferent pupillary defect with normal visual function. Arch Ophthalmol 1990;108:1074-1075: http://www.ncbi.nlm.nih.gov/pubmed?term=2136343; Eliot D, Cunningham ET, Miller NR: Fourth nerve paresis and ipsilateral relative afferent pupillary dfect without visual sensory disturbance. A sign of contralateral dorsal midbrain disease. J Clin Neuro-ophthalmol 1991;11:169-172: http://www.ncbi.nlm.nih.gov/pubmed/1836800; King JT, Galetta SL, Flamm ES: Relative afferent pupillary defect with normal vision in a glial brainstem tumor. Neurology 1991;41:945-946: http://www.ncbi.nlm.nih.gov/pubmed/204695