Pretectal syndrome with metastatic malignant melanoma to the posterior commissure

A 46-year-old man with a known metastatic tumor developed the sudden onset of upgaze paralysis, impaired convergence, eyelid retraction, pupillary light-near dissociation, convergence-retraction nystagmus, and ocular skew deviation in association with subarachnoid hemorrhage. Selective interruption of the posterior commissure by metastatic melanoma provided a precise anatomic correlation of the pretectal syndrome in man.