A Case of Parinaud Syndrome After Intracranial Hemorrhage

So Yeon Lee; Sang Won Yoon; Sung Mo Kang

doi:10.3341/jkos.2009.50.1.172

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Lee, Yoon, and Kang: A Case of Parinaud Syndrome After Intracranial Hemorrhage

Original Article

J Korean Ophthalmol Soc 2009;50(1):172-175.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.1.172

A Case of Parinaud Syndrome After Intracranial Hemorrhage

So Yeon Lee, M.D., Sang Won Yoon, M.D., Sung Mo Kang, M.D.

Department of Ophthalmology, Inha University College of Medicine, Incheon, Korea

Address reprint requests to Sung Mo Kang, MD Department of Ophthalmology, Inha University Hospital #7-206 3-ga, Shinheung-dong, Jung-gu, Incheon 400-711, Korea Tel: 82-32-890-2408, Fax: 82-32-890-2403, E-mail: ksm0724@medimail.co.kr

Received 25 November 2008 Accepted 2 May 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report one case of Parinaud syndrome after intracranial hemorrhage.

Case summary

A 45-year-old man visited our emergency department complaining of right-sided weakness and right-sided hypoesthesia. Intracranial hemorrhage in the left thalamus and intraventricular hemorrhage were noted upon brain computed tomography, and the patient was admitted to the department of neurosurgery. He complained of diplopia and upgaze palsy, and he was referred to the department of ophthalmology. The patient exhibited convergence-retraction nystagmus, light-near dissociation and vertical gaze limitation within 15 degrees. The best-corrected visual acuity of both eyes was 20/20, but convergence-retraction nystagmus and light-near dissociation still remained. Upgaze palsy was also not improved.

Conclusions

Once symptoms manifest, Parinaud syndrome does not resolve except in patients with hydrocephalus. If the findings persist for more than 6 months, the likelihood of complete resolution is very small. We reported a case of typical Parinaud syndrome with upgaze palsy, convergence-retraction nystagmus and light-near dissociation after thalamic and intraventricular hemorrhage.

Keywords: Convergence-retraction nystagmus, Light-near dissociation, Upgaze palsy

References

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Figure 1.

Brain computed tomography at initial visit shows left thalamic and intraventricular hemorrhage.

Figure 2.

Magnetic resonance imaging after 1 month of initial visit shows left thalamic and intraventricular hemorrhage.

Figure 3.

Photographs of nine cardinal direction of gaze show upgaze limitation.

Figure 4.

Lateral view of the patient. (A) The patient shows no retraction at primary gaze. The distance between the cornea and nasal bridge is 15 mm in length. (B) The patient shows the eyeball and eyelid retraction at upgaze. The distance between the cornea and nasal bridge is 17 mm in length.

Figure 5.

Photographs of the light-near dissociation. (A) Right eye shows absence of light reflex. (B) Right eye shows normal near reflex. (C) Left eye shows absence of light reflex. (D) Left eye shows normal near reflex.

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