title: Parinaud syndrome: a 25-year (1991-2016) review of 40 consecutive adult cases.
abstract: OBJECTIVE
  To characterize the clinical features, aetiology and management of ophthalmic symptoms in adult patients with Parinaud syndrome.
  
  
  METHODS
  This is a retrospective, non-comparative observational case series. We reviewed 40 consecutive charts of adult patients with the clinical diagnosis of Parinaud syndrome at the Royal Adelaide Hospital Department of Ophthalmology in Adelaide, South Australia, between 1991 and 2016. Charts were reviewed for the following: (1) demographic information, (2) clinical presentation, (3) neuro-ophthalmology signs, (4) aetiology of Parinaud syndrome, and (5) management. Examination findings were collected at initial evaluation, throughout the course of follow-up, and at last follow-up.
  
  
  RESULTS
  All the cases were assessed by one of the authors (JLC). The commonest presenting symptoms were diplopia (67.5%) and blurred vision (25%) followed by visual field defect (12.5%), ataxia (7.5%) and manifest squint (7.5%). The commonest presenting signs were vertical gaze palsy (100%), convergence-retraction nystagmus (87.5%) and light-near dissociation (65.0%). Only 65.0% patients had the classical triad of vertical gaze palsy, convergence-retraction nystagmus and light-near dissociation. Midbrain pathologies including haemorrhage (30.0%), infarction (20.0%) and tumour (15.0%) were the commonest aetiology. Pineal region tumours accounted for 30.0% of presentations. Symptoms were managed conservatively in 45% of cases with temporary occlusion, prisms or refractive correction, and observation in 42.5% of cases. Surgical intervention for refractory diplopia was required in 12.5% of cases, of which 80% reported symptom resolution following surgery.
  
  
  CONCLUSIONS
  Our series highlights the variable clinical presentation of Parinaud syndrome. The classic triad of conjugate upgaze paralysis, convergence-retraction nystagmus and light-near dissociation was only present in 65% of cases. Pineal neoplasms remain an important aetiological consideration; however, primary midbrain pathology including infarction and haemorrhage constituted the majority of our cases and should be considered in all patients. Conservative management approaches for ocular symptoms are sufficient in most cases although surgical treatment of upgaze palsy can be a useful option in refractory cases.
authors: The Royal Adelaide Hospital, Adelaide, SA, Australia.
authors: Melissa
authors: M
authors: Shields
authors: Princess Margaret Hospital and Lion's Eye Institute, Perth, WA, Australia.
authors: Swati
authors: S
authors: Sinkar
authors: The Royal Adelaide Hospital, Adelaide, SA, Australia.
authors: WengOnn
authors: W
authors: Chan
authors: The Royal Adelaide Hospital, Adelaide, SA, Australia.
authors: John
authors: J
authors: Crompton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D005133:Eye Movements / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D059906:Neuroimaging / Q000379:methods*; D015835:Ocular Motility Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D013021:South Australia / Q000453:epidemiology; D055815:Young Adult
keywords: Parinaud syndrome; dorsal midbrain syndrome; sylvian aqueduct syndrome; vertical gaze palsy