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Parinaud syndrome (divergence paralysis; subthalamic syndrome; paralysis of vertical movements; pretectal syndrome)


Parinaud Syndrome (Divergence Paralysis; Subthalamic Syndrome; Paralysis of Vertical
Movements; Pretectal Syndrome) 717e43h 717e43h 717e43h 717e43h 717e43h 717e43h

General: Various causes, including pineal tumor, supranuclear lesions, vascular lesions, inflammation, hemorrhages, midbrain lesions, lesion of posterior white commissure of pons, red nucleus, or superior cerebellar peduncle; combination of Parinaud and von Monakow syndromes is known as Gruner-Bertolotti syndrome, which consists of paralysis in upward gaze, tremors, hemiplegia, and sensory disturbances.

Ocular: Retraction of lids with lesion in mesencephalic gray matter and ptosis with lesions more anteriorly; paralysis of conjugate upward movement of the eye without paralysis of convergence; occasionally paralysis of upward and downward movement; spasm with convergence insufficiency; contralateral hemianopsia occurs when the lateral geniculate body becomes involved in case of infiltrating tumor; wide pupils that fail to react to light but sometimes react during accommodation (Holmes); papilledema (usually severe).



Clinical: Vertigo; contralateral cerebellar ataxia and choreoathetoid movement if lesion involves superior cerebellar peduncle after decussation.

Avman N, et al. Symptomatology, evaluation and treatment of aqueductal stenosis. Neurol Res 1984; 6:194-l98.

Geeraets WJ. Ocular Syndromes. 3rd ed. Philadelphia: Lea & Febiger, 1976.

Keane JR. The pretectal syndrome: 206 patients. Neurology 1990; 40:684-690.

Oppenheim JS, et al. Ependymomas of the third ventricle. Neurosurgery 1994; 34:350-353.

Parinaud H. Le Strabisme et Son Traitement. Paris: G. Doin, 1899.

Solomon RA, Stein BM. Interhemispheric approach for the surgical removal of thalamocaudate arteriovenous malformations. J Neurosurg 1987; 66:345-351.

Waltman SR. Ocular signs in midbrain disease. In: Gay AJ, Burde RM, eds. Clinical concepts of neuro-ophthalmology. Int Ophthalmol Clin 1967; 7:807.




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