Description, Causes and Risk Factors:
Parinaud syndrome is an eye problem that is similar to conjunctivitis. It usually affects only one eye and occurs with swollen lymph nodes and an illness with a fever.
Parinaud syndrome is caused by an infection by bacteria, virus, fungus, or a parasite. The most common causes are cat-scratch disease and tularemia. The bacteria that cause either condition can infect the eye. Either the bacteria can directly enter the eye (on a finger or other object), or air droplets that carry the bacteria can land on the eye.
Other infectious diseases may spread this same way, or through the bloodstream to the eye.
Parinaud's syndrome may also results from injury, either direct or compressive, to the dorsal midbrain. 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.
Classically, it has been associated with three major groups:
Women in their 20s-30s with multiple sclerosis.
Older patients following stroke of the upper brainstem.
However, any other compression, ischemia or damage to this region can produce these phenomena: obstructive hydrocephalus, midbrain hemorrhage, cerebral arteriovenous malformation, trauma and brainstem toxoplasmosis infection. Neoplasms and giant aneurysms of the posterior fossa have also been associated with the midbrain syndrome.
Vertical supranuclear ophthalmoplegia has also been associated with metabolic disorders, such as Niemann-Pick disease, Wilson's disease, kernicterus, and barbiturate overdose.
Young patients with brain tumors in the pineal gland or midbrain: pinealoma (intracranial germinomas) are the most common lesion producing this syndrome.
Red, irritated, and painful eye.
Increased tearing (possible).
Swelling of nearby lymph glands (often in front of the ear).
A loss of vertical gaze.
A diagnosis of Parinaud syndrome begins with an examination of the affected eye for signs of redness and irritation as well as the presence of tender lymph nodes near the ear. There may also be ulcers on the cornea. An ophthalmologist/PCP can order a blood test to check for signs of infection. A white blood cell count that is too low or too high is often evidence of an infection.
Additional diagnostic tests include blood tests for certain antibody levels. Laboratory cultures of eye secretions, blood, or lymph node tissue can also be helpful. A biopsy may also be performed on the affected lymph nodes. The diagnostic test will depend on the suspected cause of Parinaud syndrome.
The treatment of this syndrome depends on the illness that caused it. If a diagnosis is made early, treatment can begin immediately. Early treatment often indicates a positive prognosis for recovery. Antibiotics are used to combat infection, but infected ocular tissues may need to be removed via surgical procedure.
The eye findings of Parinaud's syndrome generally improve slowly over months, especially with resolution of the causative factor; continued resolution after the first 3-6 months of onset is uncommon. However, rapid resolution after normalization of intracranial pressure following placement of a ventriculoperitoneal shunt has been reported.
Treatment is primarily directed towards etiology of the dorsal midbrain syndrome. A thorough workup, including neuroimaging is essential to rule out anatomic lesions or other causes of this syndrome. Visually significant upgaze palsy can be relieved with bilateral inferior rectus recessions. Retraction nystagmus and convergence movement are usually improved with this procedure as well.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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