This is modeled after a case presented at the University of Iowa Department of Ophthalmology. This gentleman presents with diplopia. The abnormalities are mostly with vertical gaze, especially upgaze; the patient prefers a downward gaze. He may have some upbeat or downbeat primary position nystagmus as well as trouble with convergence and divergence. There is also some bilateral upper eyelid retraction on exam. MRI of the brain shows hydrocephalus.Challenge: This tough constellation of symptoms makes up what syndrome?
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Parinaud's syndrome (dorsal midbrain syndrome)
i'll admit i cheated and i'm still not sure i'm right..
Parinaud's syndrome?
Sun-Setting Sign, Lid Retraction (collier's sign)...???
wow! i never remember parinaud's
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EOM
This is Parinaud syndrome, also called the pretectal or dorsal midbrain syndrome which note the location of the lesion. The downward gaze preference is known as the setting sun sign. Lid retraction is Collier's sign. Etiologies include hydrocephalus, stroke, and tumor.
Sources: UpToDate; webeye.ophth.uiowa.edu.
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