Parinaud syndrome (divergence paralysis; subthalamic syndrome; paralysis of vertical movements; pretectal syndrome)

General: Various causes, including pineal tumor, supranuclear lesions, vascular lesions, inflammation, hemorrhages, midbrain lesions, lesion of posterior white commissure of pons, red nucleus, or superior cerebellar peduncle; combination of Parinaud and von Monakow syndromes is known as Gruner-Bertolotti syndrome, which consists of paralysis in upward gaze, tremors, hemiplegia, and sensory disturbances.

Ocular: Retraction of lids with lesion in mesencephalic gray matter and ptosis with lesions more anteriorly; paralysis of conjugate upward movement of the eye without paralysis of convergence; occasionally paralysis of upward and downward movement; spasm with convergence insufficiency; contralateral hemianopsia occurs when the lateral geniculate body becomes involved in case of infiltrating tumor; wide pupils that fail to react to light but sometimes react during accommodation (Holmes); papilledema (usually severe).

Clinical: Vertigo; contralateral cerebellar ataxia and choreoathetoid movement if lesion involves superior cerebellar peduncle after decussation.

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