8/19/2023 0 Comments Argyll robertson pupil bilateralTreatment is primarily directed towards etiology of the dorsal midbrain syndrome. Confirmation can be made via imaging, such as CT scan or MRI. Vertical supranuclear ophthalmoplegia has also been associated with metabolic disorders, such as Niemann-Pick disease, Wilson's disease, kernicterus, and barbiturate overdose.ĭiagnosis can be made via combination of physical exam, particularly deficits of the relevant cranial nerves. Neoplasms and giant aneurysms of the posterior fossa have also been associated with the midbrain syndrome. However, any other compression, ischemia or damage to this region can produce these phenomena: hydrocephalus, midbrain hemorrhage, cerebral arteriovenous malformation, trauma and brainstem toxoplasmosis infection. Older patients following stroke of the upper brainstem.Women in their 20s-30s with multiple sclerosis.Young patients with brain tumors in the pineal gland or midbrain, causing hydrocephalus.Specifically, compression or ischemic damage of the mesencephalic tectum, including the superior colliculus adjacent oculomotor (origin of cranial nerve III) and Edinger-Westphal nuclei, causing dysfunction to the motor function of the eye.Ĭlassically, it has been associated with three major groups: Parinaud's syndrome results from injury, either direct or compressive, to the dorsal midbrain. The area affected in Parinaud's syndrome is indicated by the striped region. It has less commonly been associated with spasm of accommodation on attempted upward gaze, pseudoabducens palsy (also known as thalamic esotropia) or slower movements of the abducting eye than the adducting eye during horizontal saccades, see-saw nystagmus and associated ocular motility deficits including skew deviation, oculomotor nerve palsy, trochlear nerve palsy and internuclear ophthalmoplegia.Ĭross section of midbrain. ![]() It is also commonly associated with bilateral papilledema. The easiest way to bring out this reaction is to ask the patient to follow down-going stripes on an optokinetic drum. ![]() On fast up-gaze, the eyes pull in and the globes retract. Convergence-retraction nystagmus: Attempts at upward gaze often produce this phenomenon.Pseudo- Argyll Robertson pupils: Accommodative paresis ensues, and pupils become mid-dilated and show light-near dissociation.Neurosurgeons see this sign most commonly in patients with hydrocephalus. In the extreme form, conjugate down gaze in the primary position, or the "setting-sun sign" is observed. This vertical palsy is supranuclear, so doll's head maneuver should elevate the eyes, but eventually all upward gaze mechanisms fail. Paralysis of upwards gaze: Downward gaze is usually preserved.Parinaud's syndrome is a cluster of abnormalities of eye movement and pupil dysfunction, characterized by: It is a group of abnormalities of eye movement and pupil dysfunction and is named for Henri Parinaud (1844–1905), considered to be the father of French ophthalmology. More specifically, compression of the vertical gaze center at the rostral interstitial nucleus of medial longitudinal fasciculus (riMLF). Parinaud's syndrome is a constellation of neurological signs indicating injury to the dorsal midbrain. Dorsal midbrain syndrome, vertical gaze palsy, upward gaze palzy, sunset sign, setting-sun sign, sun-setting sign, sunsetting sign, sunset eye sign, setting-sun phenomenon
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