To the Editor: Gareis and Johnson, in their article on intracranial neoplasms and the diencephalic syndrome (Amer J Dis Child 109:349 [Apr] 1965), demonstrate superbly in the first two figures the facial expression which may be characteristic of the syndrome. Braun and Forney1 and Dods2 have photographed patients who demonstrate a marked similarity in facial expression to the patient of Gareis and Johnson. Gareis and Johnson describe the expression as "surprisingly cheerful"; others have noted "definite alertness,"1 "amazingly alert,"2 and "eager over-alertness."3
The feature which causes the alert expression of infants with diencephalic neoplasms would appear to be a retraction of the eyelids. Retraction of the lids is generally referred to as Collier's sign4 and is seen in association with lesions of the upper brain stem.
The presence of Collier's sign in an infant with failures to thrive should immediately lead the physician to