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Central Nervous System
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
The functional outcome following treatment is often good, although the same complications of treatment experienced by medulloblastoma survivors occur. Patients presenting with severe Parinaud’s syndrome often suffer from persistence of deficit and require the input of a neuro-ophthalmologist. Patients with supra-sellar tumors may suffer from long-term endocrine problems. Recent consensus statements are available.78
Ophthalmology
Published in Shibley Rahman, Avinash Sharma, A Complete MRCP(UK) Parts 1 and 2 Written Examination Revision Guide, 2018
Shibley Rahman, Avinash Sharma
Supranuclear vertical gaze palsies, e.g. Parinaud’s syndrome. Parinaud’s syndrome is a cluster of abnormalities of eye movement and pupil dysfunction, characterised by: paralysis of up gaze, the pseudo-Argyll Robertson pupil, accommodation paresis, mid-dilated pupils, nystagmus, eyelid retraction (Collier s sign), and conjugate down gaze in the primary position: ‘setting-sun sign\
Long and short cases
Published in Vivian A. Elwell, Ramez Kirollos, Syed Al-Haddad, Neurosurgery, 2014
Vivian A. Elwell, Ramez Kirollos, Syed Al-Haddad
Eyes. Cranial nerve III palsy.Diplopia.Internuclear ophthalmoplegia (INO).Carotico-cavernous fistula.Parinaud’s syndrome.
Chameleons, red herrings, and false localizing signs in neurocritical care
Published in British Journal of Neurosurgery, 2022
Boyi Li, Tolga Sursal, Christian Bowers, Chad Cole, Chirag Gandhi, Meic Schmidt, Stephan Mayer, Fawaz Al-Mufti
Parinaud’s Syndrome, characterized by paralysis of vertical eye movements, is typically indicative of a lesion in the mesencephalon around the cerebral aqueduct and involving the corpora quadrigemina and posterior commissure.64 However, Parinaud’s syndrome has been reported as a FLS since 1899, with various case reports emerging in the 1960s and 1970s.64 A classic example of Parinaud’s syndrome is as a FLS for Pseudo-Dandy Walker Syndrome.64 Patients may present with headaches and several ocular difficulties including diplopia, difficulty with convergence, alternating fixation, and paralysis of upward eye movement, but normal corneas, visual acuity with correction, and visual fields.64 If CT and angiography are normal and cerebellar tumor excluded, iodo-ventriculography can be useful in looking for a potentially dilated and anteriorly displaced 4th ventricle past which the dye does not progress.64 4th ventricular outflow obstruction, caused by thickening of brain tissue may cause a Pseudo-Dandy Walker syndrome.64 Neurosurgical treatment of the stenosis should resolve the ocular signs.64 Thus, CSF flow is an important consideration in diagnosing cases that present with ocular symptoms such as Parinaud’s syndrome.
Hydrocephalus due to aqueductal stenosis presenting with acute bilateral ptosis: case report
Published in British Journal of Neurosurgery, 2020
Mingxing Wu, Xiushan Ge, Yanbin Li, Jiye Li, Minglei Ma, Di Wu, Xiaoyin Peng, Bingke Zhang
We found two prior reports of hydrocephalus presenting with bilateral ptosis1,2. Anatomically, levator palpebrae (LP) motor neurons lie in the central caudal nucleus (CCN) which is a subgroup of the oculomotor nucleus. The CCN lies in the caudal part of the oculomotor complex and surrounded by the dorsal tegmental nucleus and the ventromedial part of the periaqueductal gray dorsally, and by the nucleus of Perlia ventrally3–5. Lesions of CCN cause bilateral ptosis (nuclear ptosis). Lesions to pathways coursing in the floor of the third ventricle and in the rostral mesencephalon can lead to mild uni or bilateral reduction of LP tone (supranuclear ptosis)3 (Figure 6). Theoretically, hydrocephalus could affect the floor of the third ventricle and the rostral mesencephalon, so this patient maybe a presentation of supranuclear ptosis. However, vertical gaze paralysis is a more frequent finding of hydrocephalus6,7 which is a variation of Parinaud’s syndrome resulting from damage to the mesencephalon.
Surgical treatment of pineal cysts in non-hydrocephalic and neurologically intact patients: selection of surgical candidates and clinical outcome
Published in British Journal of Neurosurgery, 2019
Andrzej Koziarski, Andrzej Podgórski, Grzegorz M. Zieliński
All patients were routinely assessed at two follow-up visits scheduled at 4 and 12 months postoperatively. Clinical assessment at 4 months showed complete resolution of the preoperative symptoms in all but one patient in whom her headaches had not been adequately alleviated; 12 patients of the 22 with postoperative Parinaud syndrome had regained full ocular mobility and 5 patients still complained about occasional occipital pain. MRI scans obtained at 3–4 months post-op consistently demonstrated complete removal of the cyst with no ventricular enlargement. Upon final assessment 12 months after the surgery 27/28 (97%) patients were still free of preoperative symptoms, there was no upgaze palsy and only 2 patients (7%) reported persistent mild pain of the suboccipital region. As the treatment outcome was felt to be permanent, patients were advised that further appointments and radiological assessment would only be necessary if they felt that the symptoms were recurring. To our best knowledge none of the patients sought further attention nor needed repeat intracranial surgery according to the outpatient medical records and to the junior author’s phone conversations with several of these patients during preparation of the manuscript.