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A 22 year old man comes to your clinic complaining of gradual loss of vision over the last year. He explains that he is unable to look vertically upwards in both eyes. When he tries to, you can observe an associated nystagmus on both eyes.
On examination, you note that there is significant convergence of the eyes and retraction of the orbit. On accommodation, the pupil constricts normally, however it reacts poorly to dim light.
1. What is the most likely diagnosis in this patient ?
2. What two other major causes are associated with this syndrome ?
3. How would you manage this patient ?
4. What is the prognosis ?
5. List other causes of nystagmus.
Source: Pearce, J. (2005). Parinaud’s syndrome. Journal of Neurology, Neurosurgery, and Psychiatry, 76(1), 99. http://doi.org/10.1136/jnnp.2003.031310
1. The most likely diagnosis is Parinaud’s syndrome due to a pinealoma as can be seen on the T1 sagital MRI.
2. Multiple sclerosis
Stroke in the brainstem region in older patients.
3. Treatment is primarily directed to the aetiology of the syndrome. Normalization of ICP is done via a ventriculoperitoneal shunt. Inferior rectus recessions are used to correct the inferior rectus palsy by which the retraction nystagmus and convergence movement improve as well.
4. The overall prognosis is good as ocular findings slowly resolve completely with successful management of the etiological factor.
5. Classification of Nystagmus