WordNet

relating to or involving all stages of a business from production to distribution
something that is oriented vertically
at right angles to the plane of the horizon or a base line; "a vertical camera angle"; "the monument consists of two vertical pillars supporting a horizontal slab"; "measure the perpendicular height" (同)perpendicular
of or relating to different levels in a hierarchy (as levels of social class or income group); "vertical social mobility"
look at with fixed eyes; "The students stared at the teacher with amazement" (同)stare
a long fixed look; "he fixed his paternal gaze on me" (同)regard
a condition marked by uncontrollable tremor
affect with palsy
become friends; act friendly towards (同)pal up, chum up

PrepTutorEJDIC

『垂直の』,直立した,縦の / 垂直線(面);垂直位置
(…を)『じっと見つめる』,凝視する《+『at』(『into,on,upon』)+『名』》 / 『じっと見詰めること』,凝視
麻痺(まひ),中風 / …‘を'麻痺させる(paralyze)
《話》『友達』,仲間,親友 / (…と)仲よくなる《[『up』]『with』+『名』》

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/01/27 18:35:12」(JST)

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Parinaud's Syndrome, also known as dorsal midbrain syndrome and vertical gaze palsy, is an inability to move the eyes up or down. It is caused by a tumor of the pineal gland which compresses the vertical gaze center at the rostral interstitial nucleus of medial longitudinal fasciculus (riMLF). The eyes lose the ability to move upward.

It 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.

Signs and symptoms

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

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]
Pseudo-Argyll Robertson pupils: Accommodative paresis ensues, and pupils become mid-dilated and show light-near dissociation.
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.
Eyelid retraction (Collier's sign)
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:

Young patients with brain tumors in the pineal gland or midbrain: pinealoma (intracranial germinomas) are the most common lesion producing this syndrome.
Women in their 20s-30s with multiple sclerosis
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

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

UpToDate Contents

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1. 小児における核上性注視異常 supranuclear disorders of gaze in children
2. 進行性核上性麻痺（PSP） progressive supranuclear palsy psp
3. 後方循環系の脳血管症候群 posterior circulation cerebrovascular syndromes
4. 大脳皮質基底核変性症 corticobasal degeneration
5. 核間性眼筋麻痺 internuclear ophthalmoparesis

English Journal

Thalamic hypoperfusion in early stage of progressive supranuclear palsy(Richardson's syndrome): Report of an autopsy-confirmed case.

Kobayashi Z, Akaza M, Ishihara S, Tomimitsu H, Inadome Y, Arai T, Akiyama H, Shintani S.SourceDepartment of Neurology, JA Toride Medical Center, Ibaraki, Japan. Electronic address: zen@bg7.so-net.ne.jp.
Journal of the neurological sciences.J Neurol Sci.2013 Dec 15;335(1-2):224-7. doi: 10.1016/j.jns.2013.09.005. Epub 2013 Sep 13.
Progressive supranuclear palsy-Richardson's syndrome (PSP-RS) is a neurodegenerative disease characterized by postural instability and vertical gaze palsy, but the clinical diagnosis of PSP-RS is often difficult in the early stage of the disease. A 64-year-old male experienced frequent falls, follow
PMID 24075472

Niemann-Pick type C: a potentially treatable disorder?

Kheder A, Scott C, Olpin S, Hadjivassiliou M.SourceAcademic Department of Neurosciences, Royal Hallamshire Hospital, , Sheffield, UK.
Practical neurology.Pract Neurol.2013 Dec;13(6):382-5. doi: 10.1136/practneurol-2013-000525. Epub 2013 Aug 1.
Niemann-Pick disease refers to a group of autosomal recessive lipid storage disorders associated with a variable degree of neurological manifestations in addition to other organ involvement. Niemann-Pick disease is divided into types A-C. Of interest to neurologists is Niemann-Pick type C because of
PMID 23906593

Progressive Parkinsonism, Balance Difficulties, and Supranuclear Gaze Palsy.

Erro R, Lees AJ, Moccia M, Picillo M, Penco S, Mosca L, Vitale C, Barone P.SourceSobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, United Kingdom.
JAMA neurology.JAMA Neurol.2013 Nov 25. doi: 10.1001/jamaneurol.2013.5149. [Epub ahead of print]
A 76-year-old man presented with a 4-year history of a progressive parkinsonian syndrome. It started with slowness of gait and mood dysfunction. Symptoms slowly progressed and further included occasional unexplained falls. On examination, he showed a severe parkinsonian syndrome featuring bradykines
PMID 24275943

Japanese Journal

ドパミン作動薬誘発性開顎ジストニアを合併した進行性核上性麻痺の1例

臨床神経学 53(4), 308-311, 2013
NAID 130004921094

外転眼に注視方向性の粗大な水平性眼振をともない，中枢神経障害の関与が示唆された急性外眼筋麻痺

臨床神経学 52(6), 433-435, 2012
NAID 130004505274

緩徐な進行で長期経過を呈した進行性核上性麻痺の1剖検例

臨床神経学 52(3), 156-160, 2012
NAID 130004505251

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