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Parinaud's Syndrome is caused by lesions of the upper brain stem resulting in a cluster of abnormalities of eye movement and pupil dysfunction. It is often seen in association with pineal gland tumours
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It manifests with:
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1. Paralysis of upward gaze
2. Pseudo- Argyll Robertson pupils: Pupils become mid-dilated and show light-near dissociation.
3. Convergence-Retraction nystagmus: Attempts at upward gaze often produce this phenomenon. On fast up-gaze, the eyes pull in and the globes retract.
4. Eyelid retraction (Collier's sign)
5. Conjugate down gaze in the primary position ("setting-sun sign")
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Treatment is primarily directed towards the etiology of dorsal midbrain syndrome. 90% of patients with pure intracranial germinomas can be treated successfully by radiation therapy.
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