Parinaud's syndrome

Parinaud's syndrome
Classification and external resources
ICD-10 G46.3
ICD-9 378.81
DiseasesDB 32982
MeSH D015835

Parinaud's Syndrome, also known as dorsal midbrain syndrome is a group of abnormalities of eye movement and pupil dysfunction. It is caused by lesions of the upper brain stem and is named for Henri Parinaud[1][2] (1844–1905), considered to be the father of French ophthalmology. It is also one of the clinical manifestations of Bartonella infection.

Contents

Signs and symptoms

Parinaud's Syndrome is a cluster of abnormalities of eye movement and pupil dysfunction, characterized by:

  1. Paralysis of upgaze: Downward gaze is usually preserved. This vertical palsy is supranuclear, so doll's head maneuver should elevate the eyes, but eventually all upward gaze mechanisms fail.[3]
  2. Pseudo-Argyll Robertson pupils: Accommodative paresis ensues, and pupils become mid-dilated and show light-near dissociation.
  3. Convergence-Retraction nystagmus: Attempts at upward gaze often produce this phenomenon. On fast up-gaze, the eyes pull in and the globes retract. The easiest way to bring out this reaction is to ask the patient to follow down-going stripes on an optokinetic drum.
  4. Eyelid retraction (Collier's sign)
  5. Conjugate down gaze in the primary position: "setting-sun sign". Neurosurgeons will often see this sign most commonly in patients with failed ventriculoperitoneal shunts.

It is also commonly associated with bilateral papilledema. It has less commonly been associated with spasm of accommodation on attempted upward gaze, pseudoabducens palsy (also known as thalamic esotropia) or slower movements of the abducting eye than the adducting eye during horizontal saccades, see-saw nystagmus and associated ocular motility deficits including skew deviation, oculomotor nerve palsy, trochlear nerve palsy and internuclear ophthalmoplegia.

Causes

cross section of midbrain showing lesion

Parinaud's Syndrome results from injury, either direct or compressive, to the dorsal midbrain. Specifically, compression or ischemic damage of the mesencephalic tectum, including the superior colliculus adjacent oculomotor (origin of cranial nerve III) and Edinger-Westphal nuclei, causing dysfunction to the motor function of the eye.

Classically, it has been associated with three major groups:

  1. Young patients with brain tumors in the pineal gland or midbrain: pinealoma (intracranial germinomas) are the most common lesion producing this syndrome.
  2. Women in their 20s-30s with multiple sclerosis
  3. Older patients following stroke of the upper brainstem

However, any other compression, ischemia or damage to this region can produce these phenomena: obstructive hydrocephalus, midbrain hemorrhage, cerebral arteriovenous malformation, trauma and brainstem toxoplasmosis infection. Neoplasms and giant aneurysms of the posterior fossa have also been associated with the midbrain syndrome.

Vertical supranuclear ophthalmoplegia has also been associated with metabolic disorders, such as Niemann-Pick disease, Wilson's disease, kernicterus, and barbiturate overdose.

Prognosis and Treatment

The eye findings of Parinaud's Syndrome generally improve slowly over months, especially with resolution of the causative factor; continued resolution after the first 3-6 months of onset is uncommon. However, rapid resolution after normalization of intracranial pressure following placement of a ventriculoperitoneal shunt has been reported.

Treatment is primarily directed towards etiology of the dorsal midbrain syndrome. A thorough workup, including neuroimaging is essential to rule out anatomic lesions or other causes of this syndrome. Visually significant upgaze palsy can be relieved with bilateral inferior rectus recessions. Retraction nystagmus and convergence movement are usually improved with this procedure as well.

References

  1. ^ synd/1906 at Who Named It?
  2. ^ H. Parinaud. Paralysie des mouvements associés des yeux. Archives de neurologie, Paris, 1883, 5: 145-172.
  3. ^ [1] Neuro-Opthalmic Examination

External links

  • Aguilar-Rebolledo F, Zárate-Moysén A, Quintana-Roldán G (1998). "Parinaud's syndrome in children" (in Spanish; Castilian). Rev. Invest. Clin. 50 (3): 217–20. PMID 9763886. 
  • Waga S, Okada M, Yamamoto Y (1979). "Reversibility of Parinaud syndrome in thalamic hemorrhage". Neurology 29 (3): 407–9. PMID 571990. 
  • -1268056053 at GPnotebook

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Look at other dictionaries:

  • Parinaud's syndrome — n paralysis of the upward movements of the two eyes that is associated esp. with a lesion or compression of the superior colliculi of the midbrain …   Medical dictionary

  • Parinaud conjunctivitis syndrome — Pa·ri·naud conjunctivitis, syndrome (pah re noґ) [Henri Parinaud, French ophthalmologist, 1844–1905] see under syndrome …   Medical dictionary

  • Parinaud oculoglandular syndrome — conjunctivitis, most often unilateral and of the follicular type, followed by tenderness and enlargement of the preauricular lymph nodes; it is often associated with other infections, such as cat scratch fever, lymphogranuloma venereum, or… …   Medical dictionary

  • Parinaud conjunctivitis — Parinaud oculoglandular syndrome …   Medical dictionary

  • Syndrome de Parinaud — Le syndrome de Parinaud est un syndrome neurologique affectant la motricité oculaire. Il fut décrit en 1883 par l ophtalmologiste français Henri Parinaud[1]. Sommaire 1 Description clinique 2 Causes …   Wikipédia en Français

  • Parinaud's oculoglandular syndrome — Par·i·naud s oc·u·lo·glan·du·lar syndrome .par i nōz .äk yə lō glan jə lər n conjunctivitis that is often unilateral, is usu. characterized by dense local infiltration by lymphoid tissue with tenderness and swelling of the preauricular lymph… …   Medical dictionary

  • syndrome — The aggregate of symptoms and signs associated with any morbid process, and constituting together the picture of the disease. SEE ALSO: disease. [G. s., a running together, tumultuous concourse; (in med.) a concurrence of symptoms, fr. syn,… …   Medical dictionary

  • Parinaud — Henri, French ophthalmologist, 1844–1905. See P. conjunctivitis, P. ophthalmoplegia, P. syndrome, P. oculoglandular syndrome …   Medical dictionary

  • Parinaud syndrome — paralysis of conjugate upward movement of the eyes without paralysis of convergence, associated with lesions of the midbrain, such as a lesion in the superior colliculi or a tumor of the pineal gland …   Medical dictionary

  • Henri Parinaud — Henri Parinaud, né le 1er mai 1844 à Bellac (Haute Vienne) et mort le 23 mars 1905 à Paris, est un ophtalmologue français. Il est considéré comme le fondateur de l ophtalmologie française. Sommaire 1 Vie professionnelle …   Wikipédia en Français


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