Document resource
Background/Objective Parinaud Syndrome is characterized by a constellation of distinct neurological signs, including supranuclear upgaze palsy, convergence-retraction nystagmus, lid retraction and pupillary light-near dissociation. It arises from damage to the dorsal/tentorial aspect of the midbrain, particularly the posterior commissure and the pretectal nuclei. This condition can be caused by pineal body tumour, midbrain infarctions, multiple sclerosis, obstructive hydrocephalus and intraparenchymal haemorrhage.Method Case Report.Results We describe a case of a 54-year-old patient who initially presented to a tertiary metropolitan hospital with dense left hemiplegia. Imaging with computed tomography (CT) revealed a ganglio-capsulo-thalamic intraparenchymal haemorrhage. During conservative management with neurosurgical support at a quaternary hospital, the patient subsequently developed an upgaze palsy, convergence-retraction nystagmus, and pupillary light-near dissociation, captured on video recording. This raised concerns for obstructive hydrocephalus with further midbrain involvement. Magnetic resonance imaging (MRI) confirmed involvement of the right superior colliculus by caudal extension of the intraparenchymal haematoma with adjacent oedema. Repeat cranial nerve examination, two weeks after his presentation, demonstrated improvement in the palsy and nystagmus with persistence of light-near dissociation. The patient was discharged to a subacute hospital for inpatient rehabilitation.Conclusion This case highlights that the emergence of Parinaud Syndrome can be an indicator of worsening midbrain intraparenchymal haematoma, due to the risk of obstructive hydrocephalus, warranting close monitoring with serial imaging to monitor the progress of the haematoma. The patient’s subsequent clinical improvement demonstrates that these neurological deficits may not be permanent and can improve with the resolution of the haematoma and surrounding oedema.