Spontaneous, nontraumatic, nonhypertensive, midbrain hemorrhage is an uncommon cause of the dorsal midbrain syndrome. We describe a patient with this syndrome in whom the initial neuroimaging studies failed to clearly identify the lesion. Subsequent magnetic resonance imaging studies disclosed a dorsal midbrain hemorrhage. The patient experienced gradual spontaneous resolution of her dorsal midbrain signs and symptoms over several months. The evolution on serial neuroimaging studies of the dorsal midbrain hemorrhage in this patient is described.