{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T20:05:29Z","timestamp":1778875529242,"version":"3.51.4"},"reference-count":4,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2016,10,24]],"date-time":"2016-10-24T00:00:00Z","timestamp":1477267200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Ophthalmologica"],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To characterize the clinical features, aetiology and management of ophthalmic symptoms in adult patients with Parinaud syndrome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a retrospective, non\u2010comparative observational case series. We reviewed 40 consecutive charts of adult patients with the clinical diagnosis of Parinaud syndrome at the Royal Adelaide Hospital Department of Ophthalmology in Adelaide, South Australia, between 1991 and 2016. Charts were reviewed for the following: (1) demographic information, (2) clinical presentation, (3) neuro\u2010ophthalmology signs, (4) aetiology of Parinaud syndrome, and (5) management. Examination findings were collected at initial evaluation, throughout the course of follow\u2010up, and at last follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All the cases were assessed by one of the authors (<jats:styled-content style=\"fixed-case\">JLC<\/jats:styled-content>). The commonest presenting symptoms were diplopia (67.5%) and blurred vision (25%) followed by visual field defect (12.5%), ataxia (7.5%) and manifest squint (7.5%). The commonest presenting signs were vertical gaze palsy (100%), convergence\u2010retraction nystagmus (87.5%) and light\u2010near dissociation (65.0%). Only 65.0% patients had the classical triad of vertical gaze palsy, convergence\u2010retraction nystagmus and light\u2010near dissociation. Midbrain pathologies including haemorrhage (30.0%), infarction (20.0%) and tumour (15.0%) were the commonest aetiology. Pineal region tumours accounted for 30.0% of presentations. Symptoms were managed conservatively in 45% of cases with temporary occlusion, prisms or refractive correction, and observation in 42.5% of cases. Surgical intervention for refractory diplopia was required in 12.5% of cases, of which 80% reported symptom resolution following surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our series highlights the variable clinical presentation of Parinaud syndrome. The classic triad of conjugate upgaze paralysis, convergence\u2010retraction nystagmus and light\u2010near dissociation was only present in 65% of cases. Pineal neoplasms remain an important aetiological consideration; however, primary midbrain pathology including infarction and haemorrhage constituted the majority of our cases and should be considered in all patients. Conservative management approaches for ocular symptoms are sufficient in most cases although surgical treatment of upgaze palsy can be a useful option in refractory cases.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aos.13283","type":"journal-article","created":{"date-parts":[[2016,10,25]],"date-time":"2016-10-25T04:42:41Z","timestamp":1477370561000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":48,"title":["Parinaud syndrome: a 25\u2010year (1991\u20132016) review of 40 consecutive adult cases"],"prefix":"10.1111","volume":"95","author":[{"given":"Melissa","family":"Shields","sequence":"first","affiliation":[{"name":"The Royal Adelaide Hospital Adelaide SA Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Swati","family":"Sinkar","sequence":"additional","affiliation":[{"name":"Princess Margaret Hospital and Lion's Eye Institute Perth WA Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"WengOnn","family":"Chan","sequence":"additional","affiliation":[{"name":"The Royal Adelaide Hospital Adelaide SA Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Crompton","sequence":"additional","affiliation":[{"name":"The Royal Adelaide Hospital Adelaide SA Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,10,24]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaapos.2003.12.013"},{"key":"e_1_2_6_3_1","first-page":"206","volume-title":"Bradley's neurology in clinical practice","author":"Daroff R","year":"2016"},{"key":"e_1_2_6_4_1","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1093\/med\/9780199969289.001.0001","volume-title":"The neurology of eye movements","author":"Leigh RJ","year":"2015"},{"key":"e_1_2_6_5_1","first-page":"1200","article-title":"Multiple sclerosis presenting as Parinaud syndrome","volume":"14","author":"Quint DJ","year":"1993","journal-title":"AJNR Am J Neuroradiol"}],"container-title":["Acta Ophthalmologica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Faos.13283","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Faos.13283","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aos.13283","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,22]],"date-time":"2023-09-22T20:48:24Z","timestamp":1695415704000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/aos.13283"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,10,24]]},"references-count":4,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2017,12]]}},"alternative-id":["10.1111\/aos.13283"],"URL":"https:\/\/doi.org\/10.1111\/aos.13283","archive":["Portico"],"relation":{},"ISSN":["1755-375X","1755-3768"],"issn-type":[{"value":"1755-375X","type":"print"},{"value":"1755-3768","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,10,24]]},"assertion":[{"value":"2016-06-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-08-29","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-10-24","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}