Parinaud Syndrome – Symptoms, Causes, Diagnosis, Treatment, Prevention

Parinaud’s syndrome, also referred as pretectal syndrome, dorsal midbrain syndrome, Sunset Sign, and vertical gaze palsy, is a group of abnormalities of pupil dysfunction and eye movement.

It commonly affects only one eye and happens with an illness with a fever and swollen lymph nodes. Furthermore, it is generally associated with bilateral superior oblique palsy (a condition which you are born with) and both these eye conditions may lead to diplopia (double vision), oscillopsia, and head posture abnormality.

This syndrome is named after Henri Parinaud (1844–1905), a French neurologist and ophthalmologist, considered to be the father of French ophthalmology. He was always absorbed in work and conducted a free clinic to which his students came from afar to study.

The original description of this condition by Henri P. included convergence paralysis and upgaze palsy. Nevertheless, this definition of dorsal midbrain syndrome has now been widened to include the triad of convergence retraction nystagmus, upgaze paralysis, and pupillary light-near dissociation.

Symptoms of Parinaud Syndrome

  • lid retraction (Collier’s sign – first described in 1927 by J Collier);
  • large pupils which do not react to light, but they may respond to near-far accommodation;
  • pseudo-Argyll Robertson pupils – pupils which reduce in size on a near object;
  • swelling of nearby lymph glands;
  • if sufferers of this condition try to force upward eye movements, they usually provoke an uncontrolled contraction of various ocular muscles;
  • convergence retraction nystagmus.


The most usual causes of this problem include – tumors (about one-third of cases were due to Pineal gland tumors), strokes (it happens when the supply of blood to the brain is disrupted), and obstructive hydrocephalus (a medical term used to describe obstructive non-communicating hydrocephalus) below the cerebral aqueduct.


A diagnosis of vertical gaze palsy starts with an examination of the affected eye for any signs of irritation and redness. Also, your doctor will also check for the presence of tender lymph nodes near the ear.


It is mainly directed towards the etiology of this condition. Moreover, vertical gaze palsy can be relieved with bilateral inferior rectus recessions. 


Since the main cause of this condition is a stroke, one must focus on the overall health of the cardiovascular system.

Control Your Glycemic Levels

You can manage (and even heal) your type II diabetes mellitus with physical exercise, a strict vegetarian diet (with no oils), and weight control. More importantly, if glycemic levels are high at the time of a stroke, then brain damage is more severe and extensive.

Quit Smoking

Smoking tobacco raises the risk of stroke for smokers as well as for second-hand nonsmokers since smoking has been strongly associated with the buildup of fatty substances in the carotid artery, which supplies the neck and head with blood.

Regular Moderate Physical Exercise

Regular physical exercise will make your cardiovascular system more efficient. Also, exercise will also keep your blood pressure at a healthy level and lower your LDL and total cholesterol level.

It is recommended to have a minimum of 30 minutes (ideally 90 minutes) of moderate exercise per day.

Low On Sodium

Have a regular diet low on salt (which is about 40 percent sodium). By cutting down on sodium, you may be able to lower your hypertension as well as your risk for stroke.

Treat Atrial Fibrillation

If you have this condition, get it treated as soon as possible to lower your risk of stroke. It is a serious condition that causes an irregular heartbeat and due to this irregular heartbeat, it is easier for clots to form in the heart.

This can also increase the risk of stroke when the clots travel to the brain.

If You Drink Alcohol, Keep It Moderate

Research has concluded that if you have about one drink every day, your risk of stroke may be lower.

However, if you have more than 2 drinks per day, your risk of stroke goes up considerably. In addition, remember that alcohol is actually a drug that may interfere with prescription medicines.

Restful Sleep

Sleep at least 7 hours per night (including weekends).

Reach a Healthy Weight

If you’re obese or overweight, work with your healthcare specialist to create a reasonable weight-loss plan (a plan that you can follow regularly). In addition, controlling your weight helps you control the high-risk factors for stroke.

Lower Your Blood Pressure

If it is left untreated, hypertension weakens and damages your arteries, making them more likely to burst or clog and cause a stroke.

Eat Foods High In Dietary Fiber

A low-fat, high-fiber diet is commonly recommended, including plenty of vegetables, legumes, fruits, seeds, nuts, and whole grains.

Foods rich in fiber include – artichokes, chia seeds, flax seeds, sesame seeds, sunflower seeds, okra, brussels sprouts, broccoli, cauliflower, acorn squash, turnips, apple, mangoes, papayas, pineapples, green peas, lima beans, mung beans, red kidney beans, lentils, chickpeas, walnuts, almonds, pecans, hazelnuts, raspberries, blackberries, avocados, oatmeal, oat bran, or barley.

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