A 37-year-old patient with biopsy-proven neurosarcoidosis was admitted for a follow-up cranial MRI. Because of obstructive hydrocephalus at initial presentation, a ventriculoperitoneal shunt system had previously been implanted.
After the MRI, she developed diplopia, headache, and Parinaud syndrome (Video 1).1,2 A CT scan showed impaired CSF drainage caused by altered valve pressure settings after the MRI (Figure). Elevated CSF pressure is a frequent cause of Parinaud (dorsal midbrain or pretectal) syndrome because of the proximity of the posterior commissure and its interstitial nucleus to the aqueduct. Readjustment of the valve settings rapidly cleared the Parinaud syndrome.
Video 1
The video demonstrates the classical triad of Parinaud syndrome including vertical gaze palsy, light-near dissociation, and convergence-retraction nystagmus. In addition, lid retraction (Collier sign) can be seen. Owing to treatment with corticosteroids, the patient also presents Cushingoid facial features.Download Supplementary Video 1 via http://dx.doi.org/10.1212/200577_Video_1
(A) MRI showing normal-sized ventricles. (B) Cranial CT scan 3 days after the MRI examination demonstrating acute hydrocephalus with transependymal edema.
Study Funding
The authors report no targeted funding.
Disclosure
The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.
Appendix Authors
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Whitley Aamodt, MD, MPH.
Teaching slides links.lww.com/WNL/B908
- Received October 19, 2021.
- Accepted in final form March 7, 2022.
- © 2022 American Academy of Neurology
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