関: Parinaud's syndrome

WordNet

a pattern of symptoms indicative of some disease
a complex of concurrent things; "every word has a syndrome of meanings"
belonging to or on or near the back or upper surface of an animal or organ or part; "the dorsal fin is the vertical fin on the back of a fish and certain marine mammals"
the middle portion of the brain (同)mesencephalon

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(疾患の徴候となる一群の)症徴候,症候群 / (事件・社会的状態などのパターンを示す)徴候形態
(植物の)背部の,背の

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/05/19 10:55:19」(JST)

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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.

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.
^ [1] Neuro-Opthalmic Examination

External links

Aguilar-Rebolledo F, Zárate-Moysén A, Quintana-Roldán G (1998). "Parinaud's syndrome in children". Rev. Invest. Clin. (in Spanish; Castilian) 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

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. 松果体部腫瘍 pineal gland masses
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5. 水頭症 hydrocephalus

English Journal

Discrimination of dementia with Lewy bodies from Alzheimer's disease using voxel-based morphometry of white matter by statistical parametric mapping 8 plus diffeomorphic anatomic registration through exponentiated Lie algebra.

Nakatsuka T, Imabayashi E, Matsuda H, Sakakibara R, Inaoka T, Terada H.SourceDepartment of Radiology, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura, Chiba, 285-8741, Japan, gh23fhuw7@yahoo.co.jp.
Neuroradiology.Neuroradiology.2013 Jan 16. [Epub ahead of print]
INTRODUCTION: The purpose of this study was to identify brain atrophy specific for dementia with Lewy bodies (DLB) and to evaluate the discriminatory performance of this specific atrophy between DLB and Alzheimer's disease (AD).METHODS: We retrospectively reviewed 60 DLB and 30 AD patients who had u
PMID 23322456

Metastatic melanoma from unknown primary presenting as dorsal midbrain syndrome.

Skarbez K, Fanciullo L.SourceVA Central Western Massachusetts Healthcare System, Northampton, Massachusetts 01053, USA. kathryn.skarbez@va.gov
Optometry and vision science : official publication of the American Academy of Optometry.Optom Vis Sci.2012 Dec;89(12):e112-7. doi: 10.1097/OPX.0b013e3182771698.
PURPOSE.: Dorsal midbrain syndrome, which is characterized by upgaze paralysis, light-near dissociated pupils, eyelid retraction, and convergence retraction nystagmus, can be caused by compression, ischemia, inflammation, or injury to the dorsal midbrain. Although brain metastases are common in cert
PMID 23142879

Teaching neuroimages: dorsal midbrain (Parinaud) syndrome with corectopia.

Lindbauer N, Strenger V, Urban C.SourceFrom the Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.
Neurology.Neurology.2012 Oct 23;79(17):e154. doi: 10.1212/WNL.0b013e318270408c.
PMID 23091081

Japanese Journal

A semi-quantitative evaluation of substantia nigra hyperechogenicity in Parkinson's disease and Parkinsonian syndrome using the Gray Scale Median ultrasound analysis

沼尾文香,鈴木圭輔,竹川英宏,宮本雅之,宮本智之,岩波正興,高田悦雄,平田幸一
Neurosonology:神経超音波医学 25(1), 7-12, 2012
… Objective: Hyperechogenicity in the midbrain substantia nigra (SN) on transcranial sonography (TCS) images has been reported in Parkinson's disease (PD). … We used a semi-quantitative evaluation method, the Gray Scale Median, to quantify echogenic changes.Subjects: Hospitalized patients with PD (n = 7) or Parkinsonian syndrome (PS) (n = 7) and in-hospital control subjects (n = 6) were included. … The SN was identified within the midbrain and the areas with echogenic signals were circled and measured. …
NAID 130003316535

Loss of Goosecoid-like and DiGeorge syndrome critical region 14 in interpeduncular nucleus results in altered regulation of rapid eye movement sleep

Funato Hiromasa,Sato Makito,Sinton Christopher M.,Gautron Laurent,Williams S. Clay,Skach Amber,Elmquist Joel K.,Skoultchi Arthur I.,Yanagisawa Masashi,柳沢正史
Proceedings of the National Academy of Sciences of the United States of America 107(42), 18155-18160, 2010-10
… The expression of the states of rapid eye movement (REM) sleep and non-REM (NREM) sleep also are correlated with the activity of groups of REM-off and REM-on neurons in the dorsal brainstem. … Here we examined sleep and wakefulness in mice deficient in a homeobox transcription factor, Goosecoid-like (Gscl), which is one of the genes deleted in DiGeorge syndrome or 22q11 deletion syndrome. …
NAID 120002577309

Coexistence of Chiari 2 malformation and moyamoya syndrome in a 17-year-old girl.

Suyama Kazuhiko,Yoshida Koichi,Hayashi Kentaro,Takahata Hideaki,Yonekura Masahiro,Nagata Izumi
Neurologia medico-chirurgica 49(1), 47-49, 2009-01-15
… Magnetic resonance imaging revealed multiple infarcts in the right frontal lobe, agenesis of the corpus callosum, upward herniation of the dorsal cerebellum, tectal beak of the midbrain, and downward herniation of the cerebellar vermis. …
NAID 110007028639

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Parinaud Syndrome parinaud syndrome - Google Search | Step 2 Maloooooo | Pinterest | Pineal gland, Diff EyeRounds.org: Parinaud’s Syndrome (Dorsal Midbrain Syndrome) with bilateral Dorsal midbrain syndrome secondary to pineal gland tumours: case series and review on (PDF) Spontaneous Intracranial Hypotension Presenting as a Reversible Dorsal Midbrain Dorsal midbrain (Parinaud) syndrome - American Academy of Ophthalmology Teaching NeuroImages: Dorsal midbrain (Parinaud) syndrome with corectopia | Neurology