{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T03:49:59Z","timestamp":1793332199194,"version":"4.5.0"},"reference-count":40,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,11,6]],"date-time":"2021-11-06T00:00:00Z","timestamp":1636156800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Parinaud\u2019s syndrome involves dysfunction of the structures of the dorsal midbrain. We investigated the pathophysiology related to the signs and symptoms to better understand the symptoms of Parinaud\u2019s syndrome: diplopia, blurred vision, visual field defects, ptosis, squint, and ataxia, and Parinaud\u2019s main signs of upward gaze paralysis, upper eyelid retraction, convergence retraction nystagmus (CRN), and pseudo-Argyll Robertson pupils. In upward gaze palsy, three structures are disrupted: the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF), interstitial nucleus of Cajal (iNC), and the posterior commissure. In CRN, there is a continuous discharge of the medial rectus muscle because of the lack of inhibition of supranuclear fibers. In Collier\u2019s sign, the posterior commissure and the iNC are mainly involved. In the vicinity of the iNC, there are two essential groups of cells, the M-group cells and central caudal nuclear (CCN) group cells, which are important for vertical gaze, and eyelid control. Overstimulation of the M group of cells and increased firing rate of the CCN group causing eyelid retraction. External compression of the posterior commissure, and pretectal area causes pseudo-Argyll Robertson pupils. Pseudo-Argyll Robertson pupils constrict to accommodation and have a slight response to light (miosis) as opposed to Argyll Robertson pupils were there is no response to a light stimulus. In Parinaud\u2019s syndrome patients conserve a slight response to light because an additional pathway to a pupillary light response that involves attention to a conscious bright\/dark stimulus. Diplopia is mainly due to involvement of the trochlear nerve (IVth cranial nerve. Blurry vision is related to accommodation problems, while the visual field defects are a consequence of chronic papilledema that causes optic neuropathy. Ptosis in Parinaud\u2019s syndrome is caused by damage to the oculomotor nerve, mainly the levator palpebrae portion. We did not find a reasonable explanation for squint. Finally, ataxia is caused by compression of the superior cerebellar peduncle.<\/jats:p>","DOI":"10.3390\/brainsci11111469","type":"journal-article","created":{"date-parts":[[2021,11,7]],"date-time":"2021-11-07T20:41:14Z","timestamp":1636317674000},"page":"1469","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Understanding Parinaud\u2019s Syndrome"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7512-6140","authenticated-orcid":false,"given":"Juan Fernando","family":"Ortiz","sequence":"first","affiliation":[{"name":"California Institute of Behavioral Neuroscience & Psychology, Faifield, CA 94534, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Eissa-Garces","sequence":"additional","affiliation":[{"name":"School of Medicine, Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito 170901, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6768-8944","authenticated-orcid":false,"given":"Samir","family":"Ruxmohan","sequence":"additional","affiliation":[{"name":"Neurology Department, Larkin Community Hospital, South Miami, FL 33143, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Cuenca","sequence":"additional","affiliation":[{"name":"School of Medicine, Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito 170901, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandeep","family":"Kaur","sequence":"additional","affiliation":[{"name":"Government Medical College, Patiala 147001, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9383-0948","authenticated-orcid":false,"given":"Stephanie P.","family":"Fabara","sequence":"additional","affiliation":[{"name":"School of Medicine, Colegio de Ciencias de la Salud, Universidad Cat\u00f3lica de Santiago de Guayaquil, Guayaquil 090615, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9320-8876","authenticated-orcid":false,"given":"Mahika","family":"Khurana","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of California, Berkeley, CA 94720, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jashank","family":"Parwani","sequence":"additional","affiliation":[{"name":"School of Medicine, Neurology Department, Lokmanya Tilak Municipal Medical College, Mumbai 4000022, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Paez","sequence":"additional","affiliation":[{"name":"School of Medicine, Colegio de Ciencias de la Salud, Pontificia Universidad Cat\u00f3lica del Ecuador, Quito 170143, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatima","family":"Anwar","sequence":"additional","affiliation":[{"name":"California Institute of Behavioral Neuroscience & Psychology, Faifield, CA 94534, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5805-6619","authenticated-orcid":false,"given":"Hyder","family":"Tamton","sequence":"additional","affiliation":[{"name":"Neurology Department, Larkin Community Hospital, South Miami, FL 33143, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilson","family":"Cueva","sequence":"additional","affiliation":[{"name":"Neurology Department, Larkin Community Hospital, South Miami, FL 33143, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,6]]},"reference":[{"key":"ref_1","first-page":"258524","article-title":"A Medley of Midbrain Maladies: A Brief Review of Midbrain Anatomy and Syndromology for Radiologists","volume":"2012","author":"Ruchalski","year":"2012","journal-title":"Radiol. 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