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Parinaud Syndrome – Dorsal Midbrain — SCE Neurology MCQ

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ModerateNeuro-ophthalmologyParinaud Syndrome – Dorsal MidbrainSCE Neurology

A 45-year-old man presents with vertical diplopia, right hypertropia, and convergence-retraction nystagmus on attempted upgaze. He also has light-near dissociation of the pupils (pupils constrict to accommodation but not to light) and eyelid retraction (Collier sign). MRI brain shows a pineal mass compressing the dorsal midbrain. What is this syndrome?

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Correct answer: C — Parinaud syndrome (dorsal midbrain syndrome)

Parinaud syndrome (dorsal midbrain syndrome) results from compression of the pretectal area and superior colliculus, typically by pineal region tumours, hydrocephalus, or MS. Features include: (1) upgaze palsy (most prominent), (2) convergence-retraction nystagmus on attempted upgaze, (3) light-near dissociation of pupils (pretectal area damage disrupts the pupillary light reflex pathway while sparing the near/accommodation pathway), (4) eyelid retraction (Collier sign), and (5) skew deviation. A: Wallenberg is lateral medulla. C: Weber is ventral midbrain (CN III + hemiplegia). D: Horner is sympathetic pathway. E: Benedikt is midbrain tegmentum.

Reference: Clinical Neuroanatomy; ABN Neuro-ophthalmology Guidelines