Parinaud's syndrome

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Parinaud's ophthalmoplegia is the paralysis of conjugate movement that is associated with midbrain lesions.

The clinical features are:

  • a loss of vertical gaze
  • nystagmus on attempted convergence
  • pseudo-Argyll-Robertson pupils:
    • large pupils with sluggish reaction to light

Bilateral papilloedema is common.

The causes of Parinaud's ophthalmoplegia include:

  • pinealoma and other tumours affecting the mid-brain
  • multiple sclerosis
  • vascular lesions