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Additional recommended knowledge
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.
Parinaud's Syndrome results from injury, either direct or compressive, to the dorsal midbrain. Specifically, compression or ischemic damage of the superior colliculus within the mesencephalon, where the nucleus of the oculomotor nerve (cranial nerve III) and the Edinger-Westphal nucleus are located, cause dysfunction to the motor function of the eye.
Classically, it has been associated with 3 major groups:
However, it has been associated with obstructive hydrocephalus, midbrain hemorrhage, cerebral arteriovenous malformation, trauma and brainstem infection [toxoplasmosis]]. 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 Niemaann-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 movements are usually improved with this procedure as well.
|This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Parinaud's_syndrome". A list of authors is available in Wikipedia.|