Supranuclear vertical gaze palsy with midbrain cavernoma: A rare case of Parinaud's syndrome

Abstract

Parinaud's syndrome or dorsal midbrain syndrome is a supranuclear vertical gaze palsy, characterized by lid retraction, convergence-retraction nystagmus, light-near dissociation, and spastic-paretic accommodation. It is caused by midbrain or pineal gland tumors, stroke, obstructive hydrocephalus, thalamic hemorrhage, encephalitis, demyelination, brain abscess, and trauma. We report a case of Parinaud's syndrome in a young patient secondary to cavernoma of the midbrain, a rare vascular malformation. The major manifestations included diplopia, skew deviation, restriction of upgaze, light-near dissociation, and convergence-retraction nystagmus. In this case, the visual symptoms were the premonitory presentations instigating medical attention. Parinaud's syndrome was promptly recognized and was referred to a neurosurgeon. An expeditious neuroimaging and prompt neurosurgical intervention contributed to a favorable outcome. Midbrain tumors presenting with vertical gaze palsies have been well documented in the literature. This case highlights the role of an ophthalmologist in the early diagnosis of Parinaud's syndrome which can be instrumental in influencing further management.

Keywords

• convergence-retraction nystagmus
• light-near dissociation
• vertical gaze palsy