Parinaud Syndrome

What is Parinaud Syndrome?

Parinaud Syndrome is a set of eye abnormalities associated with eye movement anomalies and pupil dysfunction.

The syndrome named after Henri Parinaud (1844–1905), who is recognized as the father of French ophthalmology. It is caused by injury occur on the upper brain stem1.

Parinaud Syndrome lesion in midbrain superior colliculus

Symptoms

Parinaud Syndrome has following symptoms

  • Looking upward direction is difficult

Parinaud Syndrome images

  • Double vision or Diplopia: Horizontal or vertical two images formation of a single object
  • Near vision become blurred
  • Oscillopsia, in which patient experience unclear vision during movement
  • Associated neurological symptoms

Apart from the above-mentioned symptoms, following are some individual specific Parinaud Syndrome symptoms:

General Symptoms

  • Ataxia
  • Sluggish speech
  • Tremors of the hand
  • Weakness of lower limbs

Eye symptoms

  • Trouble in visual acuities
  • Abnormal head posture
  • Intraocular pressure within the normal range1,2,3

Signs

The sign of Parinaud Syndrome is divided into two components – Major components and Minor components

Parinaud Syndrome Signs Symptoms

Major Components

  • Disorder in vertical gaze
  • Defective convergence, which includes involuntary, repetitive and rapid eye movement or nystagmus.
  • Eyelid retraction
  • Pupils unable to respond against near source of light

Minor Components

  • Muscular contraction or nerve damaged of convergence
  • Muscular contraction or nerve damaged of accomodation
  • Eyes move in upward direction but from opposite side
  • One eye moves up and another eye move down, subsequently both the eyes move in the opposite direction
  • Motility deficit
  • Neurologic limitation resultant pseudoabducens palsy
  • Oculomotor nerve palsy occurs if third cranial nerve damaged
  • Impaired adduction of the eye1,2,3

Causes

Tectal plate present in the midbrain, in which the superior and inferior colliculi are located. Compression of the tectal plate causes Parinaud Syndrome. The reason of compression of tectal plate usually sporadic. The possible reason of compression may due to idiopathic brainstem hemorrhage, which may extend from the ponto-mesencephalic intersection up to the cerebral peduncles and that involves the rostral midbrain1,2,3,4.

Diagnosis

The following differential diagnosis is required to exclude the possibility of other diseases. Light -near dissociation is also included with other syndromes like the Anomalous restoration of the third nerve, Argyll Robertson pupils, Tonic pupil, Deafferention, Diabetes.

Another common sign is Vertical Gaze Palsy; but that can associate with other disorders like restricted upgaze in elderly patients, progressive supranuclear palsy, Niemann-pick disease and Whipple’s disease. Therefore, it is required to confirm that eye related sign and symptoms are not caused by other possible disorders and therefore differential diagnosis is performed1,2,3,4.

Treatment

The treatment mainly depends upon the underlying cause of the disease, as different etiologies can involve in dorsal midbrain syndrome. A detailed diagnosis including neuro-imaging like CT scan and MRI tests are essential to diagnose the actual reason of dorsal midbrain syndrome1,2,3,4.

References

  1. E NEUROSURGERY: ESSENTIAL INFORMATION FOR THE BUDDING NEUROSURGEON; http://www.eneurosurgery.com/parinaudssyndrome.html
  2. Dr. Calvin Gan, Dr. Jeremy Jones et al.; Quadrigeminal plate; https://radiopaedia.org/articles/quadrigeminal-plate
  3. J M S Pearce; Parinaud’s syndrome; J Neurol Neurosurg Psychiatry 2005;76:99; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1739319/pdf/v076p00099.pdf
  4. Rahul Bhola, Ronald V. Keech, Richard J. Olson, Dorsal Midbrain Syndrome (Parinaud’s Syndrome) with Bilateral Superior Oblique Palsy: 43-year-old male referred for evaluation of binocular diplopia; http://webeye.ophth.uiowa.edu/eyeforum/cases/case21.htm

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