Parinaud Syndrome

Synonyms:

Sylvian acqueduct syndrome a.k.a. Koeber-Salus-Elschnig syndrome

Diagnosis:

This syndrome is a clinical diagnosis. The underlying cause is determined by investigations and clinical correlation.

Clinical features:

Slightly dilated fixed pupils (i.e. no light reflex), light-near dissociation, upward gaze palsy.
Lid retraction (Collier’s sign)
Convergence-retraction nystagmus (especially on attempted up gaze)

Investigations to consider:

MRI:

  • Lesion in tectum/superior colliculus
  • E.g. pineal tumors, extending thalamic tumors, gliomas, Wernicke encephalopathy, MS plaque, tuberculoma

RPR: neurosyphilis
Consider investigations for MS

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