Parinaud's syndrome

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at October 20, 2016
StartParinaud's syndrome

Parinaud's syndrome is a condition in which pressure on the brain from a cyst or fluid causes issues with eye movement. People with this syndrome are unable to turn their eyes to look up and they frequently suffer from headaches that can be quite severe. This condition is usually treated through brain surgery where either a tumor is removed or a cerebral shunt is placed in the brain to drain fluid. This condition is also known as dorsal midbrain syndrome, and it is a rare condition that can be caused by a wide variety of different medical issues.

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Definition & Facts

People who have Parinaud's syndrome are unable to direct their gaze upward and their eyes will often be positioned oddly. Their eyes might be crossed or pointing in different directions. This is sometimes caused by a tumor in the pineal gland or lesions in the brain stem.

It is believed that up to 40% of people develop a pineal cyst in their brain during their lifetime. For most people, the cyst is benign and does not cause any issues. In select cases, the cyst grows large enough to cause Parinaud's syndrome and other issues.

It is named after Henri Parinaud, a French opthamologist famous for his work in neurology and the field of vision. He also discovered Parinaud oculoglandular syndrome, a rare form of conjunctivitis (pink eye).

Symptoms & Complaints

Those with Parinaud's syndrome display a number of symptoms that range from relatively harmless to very severe. They have vertical gaze palsy meaning they can look down but they can't move their eyes to look up. When people with Parinaud's try to look up, their eyes actually pull in and retract a bit into the eye socket. In some cases, their eyelids also retract. Their pupils are dilated.

There are a number of symptoms and warning signs of Parinaud's syndrome, including frequent headaches that are often situational. For example, some people might get headaches only when they stand up and it might be accompanied by blurred vision. Others suffer from visual disturbances, difficulties with balance and loss of coordination, periods of dizziness, nausea, and vomiting.

Hydrocephalus is another condition related to Parinaud's syndrome that causes the brain to swell due to a buildup of fluids, also known as "water on the brain." Hydrocephalus is known to cause brain damage. Some people with Parinaud's syndrome also suffer from periodic seizures. In rare cases, patients may actually lose consciousness on occasion.

Many with Parinaud's syndrome have sleep disorders, are excessively tired and sleep for longer periods of time, day and night. There are cases where people with this condition sleep up to 20 hours per day.

Causes

Parinaud's syndrome is often caused by an injury to the skull and brain. When a brain injury occurs and damage is done to certain areas of the dorsal midbrain, it can cause dysfunction in the eyes. Many who have this syndrome develop it as a complication from a brain tumor in the pineal gland.

Other times, young adult women with multiple sclerosis can develop Parinaud's syndrome. Older people who have strokes can also develop Parinaud's syndrome as a result of excess fluid and pressure.

There are a lot of different types of trauma that can cause this syndrome. Generally, anything that compresses the brain, such as a brain hemorrhage or a brain aneurysm can trigger it. Those who overdose on barbituates also sometimes develop Parinaud's syndrome as a result.

Parinaud's syndrome is a condition that tends to develop as a complication from an existing condition. A person won't get Parinaud's unless something else has occurred, such as the growth of a tumor or an aneurysm. 

Diagnosis & Tests

The diagnostic process will usually begin with a thorough physical examination. If the doctor thinks that the patient might have Parinaud's syndrome, they will start off with an eye test to determine the range of vision. After that, there might be a magnetic resonance imaging (MRI) scan and then the doctor will need to determine if surgery is warranted.

If surgery is warranted, there may be a follow-up meeting with the neurosurgeon six weeks afterwards. The patient will go through another MRI scan to see how the brain has healed. The neurosurgeon will be looking for warning signs that would indicate that the issue is not resolved. They will want to know if the patient is having any visual dysfunction, headaches or physical weakness. In some cases, a neurosurgeon might decide that another surgery is needed wherein a cerebrospinal fluid shunt is put in the brain to prevent a buildup of fluid. 

Treatment & Therapy

Often, Parinaud's syndrome is treated through a pineal cyst resection where the doctor will attempt to remove the pineal cyst. Many times, people with a pineal cyst do not need it removed. In the case of those Parinaud's syndrome, the cyst is causing problems that will likely get worse if left untreated and thus it must be removed.

When the surgery is done, the patient might have transient eye movements for a time until the body heals and adjusts. In rare cases, there might be facial drooping. Healing and recovery from the surgery takes time. In some cases, it takes a full year for the body to completely recover and operate at full capacity.

Prevention & Prophylaxis

Preventing Parinaud's syndrome is difficult beause this condition can be caused by a number of different maladies. Abstaining from using barbituates will reduce one's risk of this condition and being sure to protect the head and wear helmets when riding bikes or engaging in sports in which there is risk of traumatic brain injury is beneficial.

It is important to alert a physician if any of the warning signs are present. If Parinaud's is caused by a tumor, then the earlier the tumor is detected, the quicker it can be dealt with. Anyone who is sleeping excessively or having headaches caused by body positioning should consult a doctor immediately.