1. Video Competition MDS-PAS School For Young Neurologist Atlanta, GA, USA. 2015 Case 1

2. Male 78 years old. Benign hyperplasia prostatic treated with surgery thirty years ago. Three years ago. Abnormal gait Progressive falls Decrease on tone of his voice Dysarthric language Cephalic lateralized tremor History

3. Video

4. Audience discussion Phenomenology Differential diagnosis Investigations

5. Diagnosis Bobble - Head doll Syndrome and parinaud syndrome secundary to Pineal cyst

6. Bobble - Doll Head Syndrome Rare and an interesting movement disorder described by Benton et al (1966). Continuous or episodic forward and backward head nodding at times associated with side to side movements of the head (2-3 Hz ) It is usually associated with expansile lesions in the third ventricular region. Patient: Dysarthria, supranuclear gaze palsy with slow horizontal saccadic movements and without convergence gaze Reddy O. J Pediatr Neurosci. 2014

7. Patophysiology Due to the pressure effect of dilated third ventricle, which distorts the dorsomedial red nucleus and dentatorubrothalamic pathways. In addition, there is compression of medial thalamus, the latter having their somatotropic motor representation of head and neck area. Guerreiro H. Acta Neurochir. 2012 Reddy O. J Pediatr Neurosci. 2014