Parinaud Syndrome in a Patient With Microangiopathic Lesions in the Bilateral Gangliocapsular Region and Left Thalamus

TL;DR

A 62-year-old man with vision and walking issues was found to have Parinaud syndrome caused by brain lesions linked to high blood pressure.

Contribution

This case highlights microangiopathy as a novel cause of Parinaud syndrome beyond typical midbrain involvement.

Findings

MRI showed lesions in the thalamic and gangliocapsular regions, not the typical midbrain.

Symptoms aligned with Parinaud syndrome despite atypical lesion location.

Hypertension was likely the underlying cause of the microangiopathy.

Abstract

Parinaud syndrome, which most commonly involves the dorsal midbrain, has classical features of upward gaze paralysis, convergence-retraction nystagmus, and pupillary light near dissociation. A 62-year-old male presented to the Eye department with diminution of vision and symptoms of dry eye with associated difficulty in walking. Examination revealed nystagmus while performing convergence test. An MRI revealed lesions in the thalamic and gangliocapsular regions. Microangiopathies involving the thalamus and gangliocapsular region can lead to Parinaud syndrome. In our case, microangiopathies were most probably hypertensive.

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