The significance of down-gaze paralysis was evaluated in a study of 30 patients. Four categories were identified: (1) a reverse Parinaud syndrome (four cases) in which the lesion was either presumed to be or demonstrated to be present beneath the central gray matter of the anterior mesencephalon; (2) those cases associated with various choreo-athetotic syndromes (seven cases); (3) parkinsonoid syndromes (16 cases); and (4) miscellaneous group (three cases).
Cogan DC. Paralysis of Down-Gaze. Arch Ophthalmol. 1974;91(3):192-199. doi:10.1001/archopht.1974.03900060200009