PARINAUD'S syndrome is regarded as the result of a supranuclear lesion in the region of the midbrain. In addition to the disturbances of conjugate upward movements, pupillary abnormalities are often found in association, the lesion then being assumed to be in the vicinity of the afferent pupillomotor pathways.
In rare instances Parinaud's syndrome is associated with retraction nystagmus, and still more uncommonly these two disturbances are accompanied by retraction of the lids.
The combination of Parinaud's syndrome and retraction nystagmus is not unknown, Walsh,1 citing Bárány in this connection. Kestenbaum2 described a syndrome of the Sylvian aqueduct which, when complete, consists of the following signs: paralysis of vertical upward gaze (collicular sign), tonic convergence spasms occurring on attempted upward gaze, attacks of clonic convergence, movements, retraction nystagmus, nystagmus on vertical gaze upward or downward, pupillary disturbances, and paresis of one or more extrinsic eyemuscles.
Retraction nystagmus, first described
ASKENASY H, WIJSENBEEK H, HERZBERGER E. RETRACTION NYSTAGMUS AND RETRACTION OF EYELIDS DUE TO ARTERIOVENOUS ANEURYSM OF MIDBRAIN. AMA Arch NeurPsych. 1953;69(2):236–241. doi:10.1001/archneurpsyc.1953.02320260094007
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