Parinauds dorsal midbrain syndrome ophthalmology training. Dorsal midbrain syndrome has not been reported previously as a manifestation of sih. Download fulltext pdf chronic ataxic neuropathy mimicking dorsal midbrain syndrome article pdf available in journal of neurology, neurosurgery, and psychiatry 7811. The pupils in the dorsal midbrain syndrome are dilated and either fixed to light, or very poorly responsive to it. If there is a tumor growth, an expansion of that tumor will grow downward and then have an influence or a negative influence on the superior colliculi, for example. The usual causes of parinauds syndrome are pineal neoplasms, stroke and multiple sclerosis. The anatomy of dorsal ramus nerves and its implications in lower back pain 195 the pattern of lower back pain can be used to localize the irritated dorsal ramus or its branches based on the anatomy of spinal dorsal rami 36,39,47. Parinaud syndrome is characterized by a classic triad of findings. Sylvian aqueduct syndrome and global rostral midbrain dysfunction associated with shunt malfunction. I recently evaluated a patient whose upward gaze spontaneously improved. Dorsal midbrain syndrome associated with persistent neck. The midbrain represents the uppermost portion of the brainstem, containing numerous important nuclei and white matter tracts, most of which are involved in motor control, as well as the auditory and visual pathways.
It is caused by lesions of the upper brain stem and is named for henri parinaud 1 2 18441905, considered to. Parinauds dorsal midbrain syndrome pupils in this condition area in a middilated position, with poor light response but good near response lightnear dissociation. We describe a patient with relapsingremitting ms who developed an unusual variation of the dorsal midbrain syndrome, character ized by monocular convergentretraction nystagmus in the right eye, accompanied by divergentretraction nystagmus in the fellow eye upon attempted upward gaze. References neuro ophthalmology, american academy of ophthalmology, 20102011. Dorsal midbrain syndrome definition of dorsal midbrain.
This case provides additional evidence that dms in this setting is caused by deformation of the dorsal midbrain. The dorsal midbrain syndrome is also known as parinauds syndrome, sylvian aqueduct syndrome, or pretectal syndrome. Dorsal midbrain syndrome casebased neuroophthalmology. Parinauds syndrome results from injury, either direct or compressive, to the dorsal midbrain. Dorsal midbrain syndrome dms or parinaud syndrome is a result of involvement of structures in the rostral midbrain and pretectal area near the level of the superior colliculus including the posterior commissure. We describe a patient with this syndrome in whom the initial neuroimaging studies failed to clearly identify the lesion. In the case report titled dorsal midbrain syndrome with bilateral superior oblique palsy following brainstem hemorrhage, published in the december 2006 issue of the archives 2006. Alrashidi s, wanas am, oraby mf 2017 a case of dorsal midbrain syndrome in 2 nd trimester of pregnancy.
The preferable treatment options vary among each tumour type. Green berets ultralight bug out bag with gear recommendations duration. Spontaneous resolution of dorsal midbrain syndrome caused by a. Subsequent magnetic resonance imaging studies disclosed a dorsal midbrain hemorrhage. The most common etiologies are tumors of the pineal gland or dorsal midbrain, multiple sclerosis, strokes, and obstructive hydrocephalus 79. Patients with ms exhibit a broad diversity of ocular motor syndromes. Dorsal midbrain syndrome secondary to pineal gland tumours. Signs and symptoms of canomad may include loss of muscle, tendon, and joint sensation, abnormal gait walk, ataxia, tingling sensation on the skin around the mouth or extremities. Parinauds syndrome an overview sciencedirect topics. Brainstem stroke syndromes ppt linkedin slideshare. Describe the approach to establishing the diagnosis a. It is caused by midbrain infarction as a result of occlusion of the paramedian branches of the posterior cerebral artery or of basilar bifurcation perforating arteries. However, any other lesion in this region can cause this syndrome. Sylvian aqueduct syndrome and global rostral midbrain.
A case of dorsal midbrain syndrome in 2nd trimester of. The characteristic eye movement abnormalities of dorsal micbrain syndrome are shown and dorsal midbrain syndrome is described in detail. The anatomy of dorsal ramus nerves and its implications in. Pineal lesions are common causes of dorsal midbrain syndrome dms and typically require surgical intervention in symptomatic patients. Third nerve fibers andor third nerve nucleus on side opposite lesion hemiataxia. Lesions of the dorsal midbrain give rise to a characteristic and highly localizing constellation of neuroophthalmic signs. This is a case presentation of a young woman with a history of severe head trauma from a motor vehicle versus bicycle accident. A yearold boy presented with emesis, blurred vision, headache, and vertigo. Parinaud syndrome, also known as the dorsal midbrain syndrome, is a supranuclear vertical gaze disturbance caused by compression of the superior tectal plate. Extrinsic pressure on dorsal mesencephalon tumors in the pineal region are most common, obstructive hydrocephalus, intraventricular hemorrhage, aqueductal stenosis see figure 1. This arises in the mid brain due to sparing of the more ventrally placed near reflex pathway while a disease process affects the dorsally located light reflex fibres.
Unilateral midbrain infarct presenting as dorsal midbrain. All presented with limited upward voluntary gaze and convergence nystagmus with attempted upward voluntary gaze. Specifically, compression or ischemic damage of the mesencephalic tectum, including the superior colliculus adjacent oculomotor origin of cranial nerve iii and edingerwestphal nuclei, causing dysfunction to the motor function of the eye classically, it has been associated with three major groups. An unusual variant of the dorsal midbrain syndrome in ms. Canomad stands for chronic ataxic neuropathy ophthalmoplegia igm paraprotein cold agglutinins disialosyl antibodies. He showed signs of a dorsal midbrain parinaud syndrome supranuclear upgaze palsy, convergence retraction nystagmus. Quantitative analysis of vertical eye movements documented characteristic abnormalities of saccades with relative preservation of reflex eye. Lesions affecting the dorsal midbrain can result in a constellation of ocular findings such as vertical gaze disturbances, convergence retraction nystagmus, lig. Since this patient is suspected of having dorsal midbrain syndrome, the next most important test is an mri of the brain to look for a lesion compressing the dorsal midbrain such as pineal tumor or hydrocelphalus. Parinaud syndrome symptoms, treatment, causes, diagnosis. Over 80% of patients with pineal tumors at presentation have features of raised intracranial pressure due to blockage of the sylvian aqueduct packer et al 1984. The dorsal midbrain syndrome, or parinaud syndrome, may include trochlear palsy with upgaze weakness, downgaze limitation, convergence spasm, convergenceretraction nystagmus, lid retraction, lightnear dissociation, or a combination of these symptoms.
Dorsal midbrain syndrome pretectal or parinaud syndrome i. The dorsal midbrain syndrome is also known as parinauds syndrome, sylvian aqueduct. Dorsal midbrain syndrome pretectal or parinaud syndrome. This syndrome is due to a lesion in the midbrain tegmentum resulting from occlusion of paramedian branches of the basilar artery, the pca, or both. Quantitative analysis of vertical eye movements documented characteristic abnormalities of saccades with relative preservation of reflex eye movements ie. Parinaud syndrome is a condition that affects your eyes ability to move up and down. Dorsal midbrain syndrome parinaud s parinauds syndrome, also known as dorsal midbrain syndrome is a group of abnormalities of eye movement and pupil dysfunction. Parinaud syndrome differential diagnoses for dorsal midbrain syndrome lightnear dissociation vertical gaze palsy 61. Instead, the lesion is caused by a pineal gland tumor. With the treatment of underlying factors, the eye findings of parinauds syndrome mostly improve slowly over months 1, 2. The lesion was localized to the dorsal midbrain on neuroimaging.
Hydrocephalus may cause aqueductal stenosis leading to dilation of the third ventricle resulting in pressure on the posterior commissure. Canomad syndrome is a rare chronic immunemediated demyelinating polyneuropathy. We report clinical and oculographic findings in seven patients with the dorsal midbrain syndrome parinauds syndrome. The aim of this study was to retrospectively characterize the location and extent of brain stem lesions in children with oral motor dysfunction. Such a patient may present to the ophthalmologist but the management is the realm of the neurologist or the neurosurgeon. Webers syndrome, also known as superior alternating hemiplegia, is a form of stroke characterized by the presence of an ipsilateral oculomotor nerve palsy and contralateral hemiparesis or hemiplegia. He showed signs of a dorsal midbrain parinaud syndrome supranuclear upgaze palsy, convergence retraction nystagmus, collier sign lid retraction, pupillary lightneardissociation 1 and eccentric displacement of the pupils corectopia. This is an unusual case of dorsal midbrain syndrome because, first, it usually results from extrinsic compressive lesions such as thalamic and pineal gland tumours or untreated hydrocephalus, resulting in dilation of the aqueduct sylvia. This case of parinauds syndrome may be an unusual form of limbic encephalitis with underlying neoplasm. Lateral midbrain syndrome syndrome of small penetrating arteries arising from posterior cerebral artery on side of lesion eye down and out secondary to unopposed action of fourth and sixth cranial nerves, with dilated and unresponsive pupil. Canomad syndrome genetic and rare diseases information. Pierrotdeseilligny ch, chain f, gray f, serdaru m, escourolle r, lhermitte f 1982 parinauds syndrome. Treatment of normal pressure hydrocephalus resolves dorsal.
Supranuclear pathways and lesions linkedin slideshare. Dorsal midbrain syndrome, parinaud syndrome, pineal gland tumour. Spontaneous, nontraumatic, nonhypertensive, midbrain hemorrhage is an uncommon cause of the dorsal midbrain syndrome. A detailed diagnosis including neuroimaging like ct scan and mri tests are essential to diagnose the actual reason of dorsal midbrain syndrome 1,2,3,4. Colliers lid retraction sign, light near dissociation, upgaze paresis, convergenceretraction nystagmus, sunsetting eyes. Parinauds syndrome dorsal midbrain syndrome with bilateral superior oblique palsy. This is dorsal midbrain syndrome or pretectal or parinauds syndrome. This report describes a peculiar clinical presentation of.
Relapsing dorsal midbrain syndrome following interventions. Notable midbrain nuclei include the superior and inferior colliculus nuclei, red nucleus, substantia nigra, oculomotor nuclear complex, and trochlear nucleus. The anatomic extent of brain stem damage may provide information about clinical outcome and prognosis in children with hypoxicischemic encephalopathy and oral motor dysfunction. The zygapophysial joint line demarcates the distribution of. Lesions affecting the dorsal midbrain can result in a constellation of ocular findings such as vertical gaze disturbances, convergence retraction nystagmus, lightnear dissociation of pupils, and eyelid retraction. Pdf spontaneous intracranial hypotension presenting as a. Ipsilateral 3rd nerve palsy with contralateral chorea,tremors, athetosis. Dorsal midbrain syndrome in multiple sclerosis with magnetic resonance imaging correlation. The dorsal midbrain syndrome of parinaud usually results from damage to premotor pathways for binocular upward gaze in the dorsal mesencephalon.
Combination of features of benedicts and nothnagels syndromes. Dorsal midbrain syndrome in two cases with two different. Dorsal midbrain syndrome with bilateral superior oblique palsy. This patient developed an idiopathic brainstem hemorrhage that extended from the ponto. Acute hydrocephalus is a common cause of the parinaud dorsal midbrain syndrome.
The cause of diplopia, oscillopsia, and anomalous head posture in this patient was a combination of dorsal midbrain syndrome and bilateral superior oblique palsy. The differential diagnosis of the syndrome is extensive. What are the signs and symptoms of dorsal midbrain. Dorsal midbrain lesions have characteristic eye signs involving vertical gaze, vergence and the pupil light reflex. Spontaneous resolution of dorsal midbrain syndrome caused. Perhaps distortion of structures in this brain region can occur in sih as it does. Dorsal midbrain syndrome information including symptoms, causes, diseases, symptoms, treatments, and other medical and health issues. Most cases are related to a problem with a part of your. Dorsal midbrain syndrome due to mesencephalic hemorrhage. Pdf chronic ataxic neuropathy mimicking dorsal midbrain.