Multiple Germ Cell Tumors Manifesting as Anterior Hypothalamic and Pretectal Syndromes

ABSTRACT

A 21-year-old man presented with vertical diplopia and subsequently developed heat-dissipation deficit, central diabetes insipidus, light-near dissociation of the pupillary responses, convergence-retraction nystagmus, and mild upgaze limitation. These were consistent with the anterior hypothalamic and pretectal syndromes. Gadolinum-enhanced MRI revealed lesions, involving the suprasellar and pretectal areas, which were consistent with multiple germ cell tumors. The rare combination of anterior hypothalamic and pretectal syndromes may be manifestation of multiple germ cell tumors and require careful evaluation of these areas using gadolinum-enhanced MRI.