Pineal lesions are common causes of dorsal midbrain syndrome dms and typically require surgical intervention in symptomatic patients. We report clinical and oculographic findings in seven patients with the dorsal midbrain syndrome parinauds syndrome. 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. Dorsal midbrain lesions have characteristic eye signs involving vertical gaze, vergence and the pupil light reflex. Hydrocephalus may cause aqueductal stenosis leading to dilation of the third ventricle resulting in pressure on the posterior commissure. Green berets ultralight bug out bag with gear recommendations duration. He showed signs of a dorsal midbrain parinaud syndrome supranuclear upgaze palsy, convergence retraction nystagmus. What are the signs and symptoms of dorsal midbrain. Combination of features of benedicts and nothnagels syndromes. Dorsal midbrain syndrome secondary to pineal gland tumours. Relapsing dorsal midbrain syndrome following interventions.
Such a patient may present to the ophthalmologist but the management is the realm of the neurologist or the neurosurgeon. Spontaneous, nontraumatic, nonhypertensive, midbrain hemorrhage is an uncommon cause of the dorsal midbrain syndrome. Dorsal midbrain syndrome with bilateral superior oblique. This is a case presentation of a young woman with a history of severe head trauma from a motor vehicle versus bicycle accident.
An unusual variant of the dorsal midbrain syndrome in ms. 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. 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 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. A yearold boy presented with emesis, blurred vision, headache, and vertigo. Dorsal midbrain syndrome has not been reported previously as a manifestation of sih. I recently evaluated a patient whose upward gaze spontaneously improved. 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. Download fulltext pdf chronic ataxic neuropathy mimicking dorsal midbrain syndrome article pdf available in journal of neurology, neurosurgery, and psychiatry 7811. Canomad syndrome is a rare chronic immunemediated demyelinating polyneuropathy. Dorsal midbrain syndrome, parinaud syndrome youtube.
Colliers lid retraction sign, light near dissociation, upgaze paresis, convergenceretraction nystagmus, sunsetting eyes. Dorsal midbrain syndrome pretectal or parinaud syndrome. Pierrotdeseilligny ch, chain f, gray f, serdaru m, escourolle r, lhermitte f 1982 parinauds syndrome. Dorsal midbrain syndrome, parinaud syndrome, pineal gland tumour.
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. Spontaneous resolution of dorsal midbrain syndrome caused by a. Dorsal midbrain syndrome definition of dorsal midbrain. The dorsal midbrain syndrome is also known as parinauds syndrome, sylvian aqueduct. Unilateral midbrain infarct presenting as dorsal midbrain. This report describes a peculiar clinical presentation of. The usual causes of parinauds syndrome are pineal neoplasms, stroke and multiple sclerosis. 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 anatomy of dorsal ramus nerves and its implications in.
Subsequent magnetic resonance imaging studies disclosed a dorsal midbrain hemorrhage. 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. Treatment of normal pressure hydrocephalus resolves dorsal. All presented with limited upward voluntary gaze and convergence nystagmus with attempted upward voluntary gaze. Parinaud syndrome is characterized by a classic triad of findings.
The aim of this study was to retrospectively characterize the location and extent of brain stem lesions in children with oral motor dysfunction. 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 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. This case of parinauds syndrome may be an unusual form of limbic encephalitis with underlying neoplasm. It is caused by lesions of the upper brain stem and is named for henri parinaud 1 2 18441905, considered to. Parinauds syndrome an overview sciencedirect topics. We describe a patient with this syndrome in whom the initial neuroimaging studies failed to clearly identify the lesion. The lesion was localized to the dorsal midbrain on neuroimaging. This is dorsal midbrain syndrome or pretectal or parinauds syndrome.
Quantitative analysis of vertical eye movements documented characteristic abnormalities of saccades with relative preservation of reflex eye movements ie. Dorsal midbrain syndrome casebased neuroophthalmology. The most common etiologies are tumors of the pineal gland or dorsal midbrain, multiple sclerosis, strokes, and obstructive hydrocephalus 79. The characteristic eye movement abnormalities of dorsal micbrain syndrome are shown and dorsal midbrain syndrome is described in detail. Parinauds dorsal midbrain syndrome ophthalmology training. Sylvian aqueduct syndrome and global rostral midbrain dysfunction associated with shunt malfunction. Patients with ms exhibit a broad diversity of ocular motor syndromes. Canomad syndrome genetic and rare diseases information. Most cases are related to a problem with a part of your. Parinauds dorsal midbrain syndrome pupils in this condition area in a middilated position, with poor light response but good near response lightnear dissociation. Quantitative analysis of vertical eye movements documented characteristic abnormalities of saccades with relative preservation of reflex eye. Parinaud syndrome, also known as the dorsal midbrain syndrome, is a supranuclear vertical gaze disturbance caused by compression of the superior tectal plate. However, any other lesion in this region can cause this syndrome. 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.
The treatment mainly depends upon the underlying cause of the disease, as different etiologies can involve in dorsal midbrain syndrome. Ipsilateral 3rd nerve palsy with contralateral chorea,tremors, athetosis. Dorsal midbrain syndrome information including symptoms, causes, diseases, symptoms, treatments, and other medical and health issues. The dorsal midbrain syndrome is also known as parinauds syndrome, sylvian aqueduct syndrome, or pretectal syndrome. Supranuclear pathways and lesions linkedin slideshare. Dorsal midbrain syndrome pretectal or parinaud syndrome i. Lesions of the dorsal midbrain give rise to a characteristic and highly localizing constellation of neuroophthalmic signs. Dorsal midbrain syndrome with bilateral superior oblique palsy. 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. Instead, the lesion is caused by a pineal gland tumor.
Dorsal midbrain syndrome associated with persistent neck. Dorsal midbrain syndrome due to mesencephalic hemorrhage. Third nerve fibers andor third nerve nucleus on side opposite lesion hemiataxia. The zygapophysial joint line demarcates the distribution of. The differential diagnosis of the syndrome is extensive. Alrashidi s, wanas am, oraby mf 2017 a case of dorsal midbrain syndrome in 2 nd trimester of pregnancy. Parinaud syndrome is a condition that affects your eyes ability to move up and down. Pdf chronic ataxic neuropathy mimicking dorsal midbrain.
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. Parinauds syndrome dorsal midbrain syndrome with bilateral superior oblique palsy. Dorsal midbrain syndrome in two cases with two different. The pupils in the dorsal midbrain syndrome are dilated and either fixed to light, or very poorly responsive to it. 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. Parinaud syndrome, caused by midbrain infarction, usually.
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. Brainstem stroke syndromes ppt linkedin slideshare. Perhaps distortion of structures in this brain region can occur in sih as it does. Canomad stands for chronic ataxic neuropathy ophthalmoplegia igm paraprotein cold agglutinins disialosyl antibodies. Extrinsic pressure on dorsal mesencephalon tumors in the pineal region are most common, obstructive hydrocephalus, intraventricular hemorrhage, aqueductal stenosis see figure 1. Dorsal midbrain syndrome in multiple sclerosis with magnetic resonance imaging correlation.
Sylvian aqueduct syndrome and global rostral midbrain. Parinaud syndrome symptoms, treatment, causes, diagnosis. This case provides additional evidence that dms in this setting is caused by deformation of the dorsal midbrain. Parinauds syndrome results from injury, either direct or compressive, to the dorsal midbrain. With the treatment of underlying factors, the eye findings of parinauds syndrome mostly improve slowly over months 1, 2. This patient developed an idiopathic brainstem hemorrhage that extended from the ponto. The anatomic extent of brain stem damage may provide information about clinical outcome and prognosis in children with hypoxicischemic encephalopathy and oral motor dysfunction. Parinaud syndrome differential diagnoses for dorsal midbrain syndrome lightnear dissociation vertical gaze palsy 61. The dorsal midbrain syndrome of parinaud usually results from damage to premotor pathways for binocular upward gaze in the dorsal mesencephalon. Notable midbrain nuclei include the superior and inferior colliculus nuclei, red nucleus, substantia nigra, oculomotor nuclear complex, and trochlear nucleus. References neuro ophthalmology, american academy of ophthalmology, 20102011.
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. 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. The preferable treatment options vary among each tumour type. Describe the approach to establishing the diagnosis a. Pdf spontaneous intracranial hypotension presenting as a. 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. Acute hydrocephalus is a common cause of the parinaud dorsal midbrain syndrome. 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. Lesions affecting the dorsal midbrain can result in a constellation of ocular findings such as vertical gaze disturbances, convergence retraction nystagmus, lig. A case of dorsal midbrain syndrome in 2nd trimester of.