Parrino syndrome

A neurological disease with impaired eyeball movements is Parinaud's syndrome. Let's consider the features of this pathology, diagnostic methods and treatment.

According to the international classification of diseases ICD 10, the disorder belongs to category VI Diseases of the nervous system (G00-G99):

• G40-G47 Episodic and paroxysmal disorders
• G46* Vascular cerebral syndromes in cerebrovascular diseases (I60-I67+)
• G46.3 Parinaud's syndrome

The syndrome is included in the category of pathologies associated with pupil dysfunction and eye movement disorders. The disease is named after the father of French ophthalmology - Henri Parinaud. Vertical gaze palsy is a bilateral ptosis of the eyelids, a sluggish reaction to convergence or its absence, as well as narrow pupils. It is observed in vascular diseases, epidemic encephalitis. Patients have miosis, balance disorders, simultaneous movements of the eyeballs are limited.

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Epidemiology

The pattern of development of the spinal midbrain syndrome is associated with the presence of pathologies that can provoke it. Epidemiology indicates the following groups of patients:

• People under 40 years of age with tumors in the midbrain or pineal gland.
• Women aged 20-30 with multiple sclerosis.
• Elderly patients after upper cerebral stroke.

To reduce the incidence rate, it is necessary to reduce the risk of developing pathological conditions that cause impaired eye movement.

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Causes Parrino syndrome

There are several causes of Parinaud syndrome, let's look at them:

• Spinal cord injuries
• Lesion of the long branches of the posterior cerebral artery
• Myositis of the oculomotor muscles
• Lesion of the midbrain, posterior commissure of the diencephalon
• Displacement of the cerebral hemispheres into the tentorium cerebelli foramen
• Ischemic damage or compression of the midbrain covering

Very often the disease occurs with tumors of the pineal gland, which occurs with compression of the vertical gaze center in the interstitial rostral nucleus of the longitudinal medial fasciculus. In some patients, the disease is diagnosed after jaundice, Niemann-Pick disease, Wilson disease, and barbiturate overdose.

The pathology is part of the mesencephalic syndrome (displacement stage) and can occur simultaneously with sluggish pupillary reactions and vertical nystagmus. In rare cases, the disorder provokes hemorrhages in the midbrain, cerebral arteriovenous malformation, obstructive hydrocephalus, toxoplasmosis or traumatic infectious lesion of the brain stem. Neoplasms of the posterior cranial fossa and aneurysms can also be associated with supranuclear palsy of associated eye movements.

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Risk factors

Doctors identify certain risk factors that can trigger Parinaud's syndrome, let's look at them:

• Tumor lesions of the pituitary gland.
• Metastatic tumors.
• Hydrocephalus and hydrocephalus shunt dysfunction.
• Lesions of the central nervous system.
• Hypoxia.
• Neurosurgical trauma.
• Syphilis.
• Tuberculosis.
• Multiple sclerosis.
• Lipidoses.
• Vitamin B12 deficiency.

In some cases, limitation of upward gaze is caused by Parkinson's disease, Wernicke's encephalopathy, Fisher's syndrome, Lambert-Eaton syndrome, and other pathologies with similar symptoms.

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Pathogenesis

The mechanism of vertical gaze paralysis development depends entirely on the cause of its origin. Pathogenesis may be associated with brainstem encephalitis or develop against the background of hydrocephalus, tumor of the quadrigeminal body, pituitary region or epiphysis. Paralysis is characterized by a disruption of signal transmission from the brain to the eye.

If the pathological condition is based on damage to the pretectal area, then the development of Vincent-Alajouanine syndrome in combination with Argyll-Robertson syndrome and Parinaud syndrome is possible. Impaired upward eye movement is accompanied by bilateral paralysis of the oculomotor nerves and paralytic mydriasis.

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Symptoms Parrino syndrome

Clinical symptoms of Parinaud syndrome include paresis of upward gaze combined with convergence paralysis. Pupillary reactions may also be impaired. These signs may indicate displacement of the cerebral hemispheres into the tentorium cerebelli foramen.

The main symptoms of supranuclear palsy of associated eye movements:

• Upper gaze palsy.
• Eyelid retraction.
• Conjugation of downward gaze in the preferred position.
• Disturbance of balance.
• Bilateral optic nerve edema.
• Argyll-Robertson pseudopupil (accommodative paralysis, dilated pupils, bright-near dissociation).
• Convergence-retraction nystagmus (may develop due to attempts to look up).

If the disease is congenital, then hypertensive-hydrocephalic syndrome is observed, that is, an increase in the size of the skull, divergence of the sutures and damage to the cranial nerves, developmental delay (physical, mental), decreased motor activity of the arms and legs.

First signs

The symptoms of mesencephalic syndrome largely depend on its cause. The first signs of Parinaud syndrome caused by a tumor neoplasm are as follows:

• Morning headaches and dizziness.
• Nausea and vomiting.
• Double vision.
• Decreased visual and hearing acuity.
• Increased weakness.
• Impaired sensitivity in one half of the body.
• Increased drowsiness.
• Change in body weight.
• Epileptic seizures.
• Hypertensive-hydrocephalic crises.

Against the background of the above symptoms, there is a weakening of the pupils' reaction to light and convergence with accommodation. The pupil does not change, anisocoria is possible. Gradually, vertical paresis of downward gaze develops. There may also be pathological retractions of the upper eyelids. When looking straight ahead, a white strip of sclera between the edge of the eyelid and the corneal limbus and their trembling are visible. Ataxia, pathological breathing, altered consciousness and rapid involuntary contractions of the muscles of one half of the body, i.e. hemitremor, are possible.

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Stages

A neurological disorder characterized by gaze paralysis has several types and stages.

Stages of Parinaud syndrome:

• Early - impairment of neurological functions controlled by the cortex and diencephalon. The severity of pathological symptoms depends on the degree of residual preservation of the cerebral cortex and diencephalic reticular formation. Most often, patients experience respiratory disorders, sleep disorders, and general weakness. Pupils are small and react to light. Motor reactions to stimuli depend on the localization and prevalence of the primary lesion.
• Diencephalic is a lesion of the midbrain and pons. At this stage, a comatose state may develop. Breathing is normalized, becomes even and regular. Pupils are of medium size, but do not react to light. Eye movements are inconsistent, oculocephalic and oculovestibular reflexes are possible.
• Decerebration – the peculiarity of this stage is its spontaneous development. Breathing slows down and becomes irregular. Pupils are of average size, do not react to light, there are no reflex eye movements. Flexor hypertension in the legs gradually develops, extensor muscle hypertension decreases.
• Terminal is the final stage, in which the medulla oblongata is affected. Breathing is difficult and slow. Heart rate and blood pressure change. Pupils dilate due to tissue anoxia. Without active resuscitation, severe brain damage occurs, and death is possible.

Depending on the stage of supranuclear palsy of associated eye movements, the methods of its diagnosis and treatment depend.

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Forms

Paralysis of upward gaze in combination with impaired convergence of the eyes and spasms of the eyeballs is Parinaud's syndrome. The types of disorder depend on the degree of damage, i.e. the prevalence of the pathological process:

• Horizontal gaze paralysis (damage to the frontal lobe of the brain).
• Vertical gaze palsy (damage to the midbrain or pathways to it).

Most often, the disease develops due to a tumor of the pineal gland. This is manifested by paresis of upward gaze, impaired pupillary reactions and convergence paralysis. With the progression of pathological symptoms, displacements with oculomotor disorders (ptosis, limited mobility of the eyeballs) are observed. Subsequently, compression of the peduncle of the brain occurs, which is manifested as tone disorders in the limbs, hyperkinesis, intention tremor.

If the displacement increases, then symptoms of mesencephalic-pontine and pontine-bulbar syndromes, cerebellar and occlusive-hydrocephalic syndromes appear. With further progression, symptoms of parkinsonism and supranuclear ophthalmoplegia are possible.

Complications and consequences

If the treatment of Parinaud's syndrome was started too late or the therapy was ineffective, then various consequences and complications are possible. This is manifested by signs of dysfunction of the midbrain. In 8% of patients, diabetes insipidus develops, which is caused by downward compression of the pituitary stalk and the median eminence of the hypothalamus.

Most often, pronounced pathological fluctuations in body temperature are observed; hyperthermia can suddenly change to hypothermia. Superficial rare respiratory movements gradually worsen, become more frequent and turn into tachypnea. With further progression and damage to the brain, a fatal outcome is possible.

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Diagnostics Parrino syndrome

Based on the general signs that are determined visually, Parinaud's syndrome is diagnosed. The doctor prescribes a comprehensive clinical examination aimed at excluding anatomical disorders and other causes of the neurological condition.

Diagnosis largely depends on the cause of the disorder. If the disorder is associated with craniocerebral trauma or neoplasms in the brain, various instrumental methods are used in combination with laboratory tests. If vertical gaze paralysis is combined with paresis of downward gaze, the patient is diagnosed with Sylvian aqueduct syndrome and appropriate diagnostic procedures are performed.

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Tests

Laboratory diagnostics of Parinaud's syndrome consists of a clinical blood test and biochemistry, research to identify rheumatoid factor and myositis-specific antibodies, analysis of urine, feces and other biological fluids. Tests are necessary to identify possible causes of the pathological condition and a comprehensive examination of the body.

In cases of spinal cord injuries, cerebrospinal fluid analysis and somatosensory potential testing are performed. If there is a suspicion of oncology, then an analysis for tumor markers is indicated. Laboratory tests are also performed to identify infectious causes of oculomotor disorders.

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Instrumental diagnostics

The most common cause of spinal midbrain syndrome are tumors of the pineal gland. Various instrumental diagnostic methods are used to detect them, let's consider them:

• Computed tomography – using X-rays, layer-by-layer images of areas of the body affected by pathology are obtained.
• Magnetic resonance imaging is a non-invasive imaging technique for visualizing tumors and assessing the severity of brain tissue damage.
• Electromyography and electroneurography – assessment of the electrical activity of muscle tissue and determination of the speed of conduction of electrical impulses along nerve fibers.
• A lumbar puncture is the collection of samples of cerebrospinal fluid and their subsequent examination for atypical cells (malignant process).

In addition to the above studies, the following may be prescribed: pneumomyelography, myelography, venticulography, echoencephaloscopy. All diagnostics are carried out under the supervision of a neurologist.

Differential diagnosis

There are many neurological diseases whose symptoms are similar to those of vertical gaze palsy. Differential diagnostics are performed to separate the true pathology from similar disorders.

Differentiation of Parinaud's syndrome is carried out with the following diseases:

• Systemic vasculitis.
• Tumors of the orbit and base of the skull.
• Orbital phlegmon.
• Carotid artery aneurysm.
• Aneurysms of the arteries of the circle of Willis.
• Brainstem encephalitis.
• Malignant exophthalmos.
• Liqueur hypertension.
• Oculopharyngeal muscular dystrophy.
• Metastases to the orbit from lung or breast cancer.
• Temporal arteritis.

The neurological disorder is compared to the phenomenon of "doll's eyes", when the patient cannot follow a moving object, but can fix his gaze on the object and passively tilt and turn his head. If there is a suspicion of Bell's phenomenon, then supranuclear vertical gaze palsies are observed.

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Treatment Parrino syndrome

Impaired upward eye movement has no specific therapy. Treatment of Parinaud's syndrome is aimed at eliminating the cause, if possible, that caused it. That is, all the emphasis is on the etiology of the disease. If the disorder is infectious in nature, then massive antibiotic therapy in combination with corticotherapy is indicated. In case of tumor invasions, X-ray therapy and surgery are performed.

If the disorder is related to injuries, then surgical intervention is possible. The patient undergoes bilateral recession of the lower rectus muscle, which frees the upper gaze, improves convergence movement and nystagmus retraction. The treatment is supplemented by taking vitamin complexes and physiotherapy.

Medicines

The treatment plan and choice of drugs for Parinaud's syndrome depend entirely on the cause of the disease. The medications are selected by the attending physician based on the anamnesis and etiology of the pathological condition.

1. Spinal cord injuries - medications are selected based on the nature of the injury. As a rule, these are broad-spectrum antibiotics (Amoxicillin, Tetracycline, Ciprofloxacin, Chloramphenicol), in case of spinal shock, Dopamine and Atropine are used. To eliminate the effects of cerebral hypoxia, Diphenin, Relanium and vitamin E are indicated.

• Amoxicillin

A bactericidal antibiotic with a broad spectrum of action from the group of semi-synthetic penicillins. It is used for various inflammatory lesions and for them. It has several forms of release (tablets, capsules, solution for oral use, suspension, powder for injections). The dosage and duration of therapy depend on the indications for use. Side effects are manifested in the form of allergic reactions (urticaria, swelling, conjunctivitis), joint pain and the development of superinfection are possible. The main contraindication is hypersensitivity to penicillins, pregnancy, a tendency to allergic reactions.

• Dopamine

Used in shock conditions of various etiologies. Improves hemodynamics in vascular insufficiency and other pathological conditions. Used intravenously by drip with a glucose solution or isotonic sodium chloride solution. Side effects can cause increased heart rate, ischemia, arrhythmia. Contraindicated for use in thyroid diseases, adrenal tumors, heart rhythm disorders.

• Relanium

It is prescribed to eliminate convulsive states of various etiologies, acute psychomotor agitation, neurotic and neurosis-like disorders. It has several forms of release, which determine the method of application. Depending on the patient's condition, the doctor prescribes the dosage and course of treatment. Contraindications: myasthenia, closed-angle glaucoma, shock. Overdose manifests itself in the form of depression of consciousness of varying severity, decreased blood pressure, increased drowsiness. Symptomatic therapy and gastric lavage are indicated to eliminate this condition.

2. Myositis of the oculomotor muscles - symptomatic therapy is indicated using anti-inflammatory NSAIDs (Analgin, Ibuprofen, Akamizon) and painkillers (Ibuclin, Tempalgin). It is also possible to use antibiotics, corticosteroids and immunosuppressants.

• Diclofen

A derivative of phenylacetic acid with anti-inflammatory and analgesic properties. It is used for inflammatory and degenerative diseases of the musculoskeletal system, severe pain syndrome, algomenorrhea, infectious and inflammatory lesions of the body. The drug is taken 25 mg 2-3 times a day, the duration of treatment is determined by the doctor. The drug is contraindicated in case of hypersensitivity to its components, aspirin triad, blood clotting disorders, during pregnancy and erosive and ulcerative lesions of the gastrointestinal tract. Side effects are manifested by unfavorable symptoms from all organs and systems. Most often, patients experience allergic reactions, nausea, vomiting, dizziness, increased drowsiness.

• Spazmalgon

A combined analgesic with a pronounced antispasmodic effect. It is used for severe pain caused by smooth muscle spasms and painful sensations of other etiologies. The drug is available in the form of tablets for oral administration. For treatment, 1-2 tablets are prescribed 2-3 times a day, but no more than 6 tablets per day. Side effects include gastrointestinal disorders, nausea and vomiting, pain in the epigastric region. Allergic reactions, increased blood pressure, headaches, and difficulty urinating are also possible. Spazmolgon is contraindicated in case of intolerance to its components, suspicions of surgical pathologies, disorders of the hematopoietic system, severe renal/hepatic insufficiency.

3. Multiple sclerosis - treatment of the spinal cord and brain disorder is complex and quite long. Oculomotor disorders of varying severity can appear at all stages of the disease. For treatment, drugs are used that stop the progression of the pathology: Dexamethasone, Prednisolone, ACTH, and others.

• Dexamethasone

Glucocorticosteroid with anti-inflammatory and antiallergic properties. It is used in cases of a sharp drop in blood pressure, shock after injury or surgery, severe infectious lesions, allergic conditions. The dosage is individual for each patient, as a rule, the drug is taken 10-15 mg 1-2 times a day. Side effects: nausea, dizziness, depression of consciousness, allergic reactions.

• Novantron

Antitumor agent. It is used for multiple sclerosis at all stages, oncological lesions of the mammary gland, non-Hodgkin's lymphoma, leukemia. It has several forms of release, the dosage depends on the indications for use and the doctor's recommendations. The drug is contraindicated in case of hypersensitivity to its components, during pregnancy and lactation, acute myocardial infarction, angina pectoris, infectious diseases. Side effects are manifested in the form of suppression of hematopoiesis, disorders of the digestive system. Allergic and local reactions are possible. Treatment is symptomatic.

4. Upper brain stroke - drug therapy is used as an auxiliary, since the main emphasis is on surgical intervention. The following drugs can be prescribed: Flunarizine, Nimodipine.

• Flunarizine

A drug that relaxes smooth muscles and blocks calcium channels. Improves cerebral circulation, reduces the severity of vestibular disorders. Has antihistamine and anticonvulsant effects. Prescribed for dizziness due to cerebrovascular disorders and vestibular disorders. The drug is taken 10 mg once a day. Side effects include drowsiness, extrapyramidal disorders, and changes in body weight.

• Nimodipine

Calcium ion antagonist, affects the blood supply to the brain and reduces hypoxic phenomena. It is used to treat and prevent ischemic disorders of cerebral circulation. The dosage and duration of treatment depend on the severity of the pathological condition. Possible side effects: hypotension, headaches and other dyspeptic phenomena. The drug is contraindicated in pregnancy, cerebral edema, renal dysfunction and acute increase in intracranial pressure.

5. Tumors in the midbrain or pineal gland – surgical treatment, combined with radiation therapy and medications. Patients are prescribed anti-inflammatory and analgesic drugs – Ketofen, antidepressants – Amitriptyline, antipsychotic and diuretic drugs – Haloperidol, Hydrochlorothiazide and other drugs.

• Amitriptyline

A tricyclic antidepressant with a pronounced sedative and thymoanaleptic effect. It is used for depressive states, anxiety-depressive and emotional disorders, neurogenic pain and for the prevention of migraines. The drug is taken orally at 50-75 mg per day in 2-3 doses. Side effects provoke an increase in intraocular pressure, dry mouth, constipation, increased body temperature, headaches, increased weakness. Overdose is manifested by an increase in side effects, to eliminate it, it is necessary to stop therapy. The antidepressant is contraindicated in heart failure, arterial hypertension, ulcerative lesions of the gastrointestinal tract, conduction disorders of the heart muscle.

• Haloperidol

A neuroleptic with antipsychotic action. It is used in delusional states, hallucinations, acute and chronic psychoses, as well as in complex therapy of pain syndrome. The drug is taken at 150-300 mg per day, with intramuscular and intravenous administration, 0.4-1 ml of 0.5% solution is indicated. Side effects are manifested in the form of extrapyramidal disorders and insomnia. The drug is contraindicated in organic lesions of the central nervous system, cardiac conduction disorders and kidney disease.

All the above-described drugs are used only as prescribed by a doctor and after establishing the true cause of vertical gaze paralysis.

Vitamins

Supranuclear palsy of associated eye movements requires comprehensive treatment. Vitamins are prescribed in combination with the main therapy of the disease that caused Parinaud's syndrome. Vitamin preparations are necessary to strengthen the eye muscle and restore its function. The eyes need both fat-soluble (A, E, D) and water-soluble (C, B) vitamins.

• A – retinol is a component of the visual pigment that converts light entering the retina into nerve impulses. Deficiency of this substance affects visual acuity and reduces the protective properties of the immune system.
• E, D – tocopherol is used for myopia, as it minimizes the risk of retinal detachment. Calciferol improves calcium absorption and is necessary for normal muscle contraction.
• C – ascorbic acid strengthens the walls of blood vessels in the eyes and improves blood supply. It is used to prevent cataracts, reduce eye muscle tension and fatigue.
• Group B – vitamin B1 is involved in the transmission of nerve impulses in the optic nerves and the formation of an enzyme that reduces intraocular pressure. B2 is part of the visual pigment and protects the retina from UV radiation. B3 improves blood supply to the eye by reducing cholesterol levels in the blood, regulates higher nervous activity. B6 relieves eye strain, prevents disorders and inflammation of the optic nerve. B12 improves the condition of the optic nerve, is used to prevent glaucoma.
• Lutein – strengthens the lens and retina, protects against pathological changes, maintains normal functioning of the eye. Suppresses the formation of free radicals, reflects harmful blue light, improves the performance of neurons in the central zone of the retina. Increases visual acuity, has antioxidant properties.
• Anthocyanins are anti-inflammatory compounds and antioxidants that protect against retinopathy. The substances strengthen the walls of the blood vessels of the retina and promote the removal of lipofuscin from the eye tissue.
• Zinc – a deficiency of this mineral disrupts the absorption of glucose by the lens of the eye and can lead to the development of cataracts.
• Omega-3 – improves nutrition of the eyeball, maintains the health of the retina, prevents inflammatory processes.
• Selenium – removes oxidation products from the body and stops age-related destruction of the visual apparatus. Protects eye tissue from oxygen radicals.
• Copper – this microelement is part of the enzymatic antioxidant protection of the body. Improves the absorption of iron, which is necessary for the synthesis of hemoglobin. Accelerates the oxidation of vitamin C and takes part in the healing processes.
• Potassium – improves blood supply to the visual organs, combats eye fatigue.

All the above vitamins and minerals are present in food products. There are also specialized dietary supplements and food additives that are useful for oculomotor disorders.

Physiotherapy treatment

Any degree of eye movement disorder requires complex therapy. Physiotherapeutic treatment of Parinaud's syndrome is aimed at strengthening the muscle responsible for the movement of the visual organs. The patient is prescribed:

• Massage.
• Pharmacopuncture.
• Hirudotherapy.
• Paraffin-ozokerite and mud applications.
• Magnetic therapy.
• Laser therapy.
• Physiotherapy exercises.

Physiotherapy is used at the initial stages of the disorder, for its prevention and reduction of pathological deviations. However, without drug treatment, exercises will not help eliminate the disorders.

Folk remedies

Treatment of spinal midbrain syndrome depends entirely on the causes that provoked it. Traditional treatment is used for mild eye muscle injuries that are not associated with severe pathological processes in the body.

Let's look at popular recipes for treating eye movement paresis:

• If paralysis is associated with Parkinson's disease, which appeared against the background of atherosclerosis of the cerebral vessels, then it is recommended to take feijoa juice and fruits. This plant leads to a lasting improvement.
• Pour 250 ml of boiling water over a teaspoon of dried peony roots, wrap it up and let it brew for 1 hour. Once the infusion has cooled, strain it and take 1 tablespoon 3 times a day 20 minutes before meals. Peony alcohol tincture (pharmacy product) has medicinal properties; take 30-40 drops 3 times a day.
• Pour 250 ml of boiling water over a teaspoon of sumac leaves and let it brew for an hour. Strain the mixture and take 1 tablespoon 3-4 times a day.
• Pour 250 ml of boiling water over two teaspoons of crowberry herb, simmer over low heat and let steep for 2 hours. After cooling, strain and take 1/3 cup 3 times a day.

Before using alternative treatment methods, you should consult with your doctor.

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Herbal treatment

If Parinaud's syndrome is associated with pathologies of the central nervous system, many patients resort to herbal treatment. This method is effective if the weakening of motor functions and the reduction of eye muscle strength are associated with disorders of the nervous system.

• Pour 250 ml of boiling water over one tablespoon of dragonhead and let it brew for 2-3 hours. Take 3 tablespoons 2-3 times a day before meals. If desired, you can add a spoonful of honey to the medicine.
• Pour 250 ml of boiling water over two teaspoons of dry Peony root and leave for 1-2 hours. After cooling, strain and take 1/3 cup 2-3 times a day before meals. This recipe is effective for nerve damage and paresis.
• If the disorder is of an infectious nature, then you can use fresh purslane. Pour 1 tablespoon of plant material with 250-300 ml of boiling water and leave for 2 hours. Take 2-3 spoons before meals 3-4 times a day.
• Pour 250 ml of boiling water over 5 g of tobacco leaves and let it brew for 1 hour. After cooling, strain the infusion and take 1 tablespoon 2-3 times a day. If desired, you can add a spoonful of honey to the medicine.

To prevent possible allergic and other side reactions, before using the above recipes, you should consult with your doctor.

Homeopathy

An alternative method of treating many diseases is homeopathy. For vertical gaze paralysis, the following remedies are recommended:

• Gelseminum – used for paralysis of the eye muscles and paresis of the pectoral muscles.
• Causticum – used for all types of paresis. The medicine can be taken in combination with other drugs.
• Kalium jodatum – effective in paralysis of the abducens nerves of the eye.
• Mercurius jodatus flavus – oculomotor disorders of any etiology, complete paralysis of all eye fibers.

The above-mentioned drugs can be taken only as prescribed by a homeopathic physician, who selects the medication and its dosage for each patient individually. As a rule, the drugs are taken in a 30-fold dilution until the pathological symptoms are reduced.

Surgical treatment

If Parinaud's syndrome has a tumor origin, then surgical treatment is indicated. Surgical intervention is performed in case of severe spinal cord injuries, midbrain lesions and other neurosurgical pathologies.

Most often, the operation is performed for tumors of the pineal gland, which compresses the center of vertical gaze, causing paralysis of the gaze. This treatment is supplemented by radiation and chemotherapy, which is aimed at destroying malignant cells. If the oculomotor disorder is associated with a stroke, then the operation is not performed. Therapy is aimed at restoring some functions of gaze control.

Prevention

Prevention of oculomotor disorders is based on the prevention of diseases that can cause paresis. Prevention of Parinaud's syndrome consists of:

• Timely treatment of infectious and any other diseases.
• Observe safety precautions at all times to prevent spinal cord or brain injury.
• Giving up bad habits: smoking, alcohol.
• Maintaining a healthy, fractional diet.
• Healthy lifestyle and regular exercise.
• Vitamin therapy.
• Blood pressure control.
• Regular preventive examinations with a doctor.

The above preventive recommendations will help to minimize the risk of developing supranuclear palsy of associated eye movements.

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Forecast

The outcome of vertical gaze palsy depends on the severity of the lesions, their nature and the etiologic factor. The prognosis of Parinaud's syndrome varies considerably. Depending on the nature of the pathological condition, recovery may occur quickly or not at all.

For example, inflammatory diseases are treated for several months. While patients with ischemic optic neuropathy may remain permanently with limited upward gaze. In case of traumatic lesions of the brain or spinal cord, ventriculoperitoneal shunting is possible to stabilize intracranial pressure.

Parinaud syndrome requires comprehensive diagnostics and a comprehensive approach to treatment. The sooner the cause of the disorder is established, the higher the chances of eliminating the disorder and minimizing its pathological complications.

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