Parinaud's syndrome as a sign of acute obstructive hydrocephalus: recovery after acute ventriculostomy

Paresis or palsy of upward vertical gaze, pupillary light-near dissociation and nystagmus retractorius with convergence, were present in a boy aged 16 years and a woman aged 30 years with an obstructive hydrocephalus due to an aqueductal stenosis as a consequence of a bacterial meningitis and in a woman aged 26 years and a man aged 47 years with an outlet obstruction of the fourth ventricle after a posterior fossa operation for a tumour in the fourth ventricle. All of the patients were suspected of having a drain dysfunction. They all underwent a third-ventriculocisternostomy after which their symptoms (partially) resolved. The presenting symptoms stated are the classical triad of Parinaud's syndrome. In addition to these there are less frequent symptoms such as bilateral eyelid retraction (Collier's sign) and convergence spasms. The syndrome is rare but has a significant mortality risk and a high morbidity rate if an obstructive hydrocephalus is not diagnosed and treated. An MRI scan of the cerebrum to detect obstructive hydrocephalus with dilation of the aqueduct is the diagnostic of choice. For an obstructive hydrocephalus with dilation of the aqueduct a third-ventriculocisternostomy is the treatment of choice.