Putting the Puzzle Together: Case Report of Parinaud Syndrome in a Pediatric Patient

Parinaud syndrome, also known as dorsal midbrain syndrome, is a condition affecting the dorsal midbrain region of the brainstem that presents with a triad of ophthalmic clinical findings, including upgaze paresis, convergence retraction nystagmus, and light-near dissociation. This case report will discuss the clinical presentation of Parinaud syndrome in a four-year-old patient who was seen in an out-patient clinic for intermittent exotropia 5 months after a suboccipital craniotomy resection of a pineal mass and ventriculoperitoneal (VP) shunt placement for associated hydrocephalus. Current literature is relatively sparse regarding the presentation of Parinaud syndrome in the pediatric population, with little known about prognosis and potential for recovery. The purpose of this case report is to identify the neuro-ophthalmic clinical findings associated with a pineal mass, examine how these findings may present in a pediatric patient, and discuss in detail the neuroanatomy and pathophysiology of the major clinical findings associated with Parinaud syndrome.