Parinaud Syndrome in Association with Thalamic Infarct in a Young Person

Abstract

Aim: We report a case of Parinaud syndrome secondary to an acute left posteromedial thalamic infarct in a young person. Presentation of Case: Patient's main presenting complaints were blurring of vision and diplopia. The main clinical manifestations were that of a severe restriction in upward gaze, and convergence-retraction nystagmus. Discussion: Vertical gaze palsies have been well associated with midbrain lesions but more rarely associated with seemingly isolated thalamic lesions.  This case report further supports current limited literature that suggests that thalamic lesions may also manifest as vertical gaze palsies. In addition, cases of cerebrovascular events are usually first seen in the Emergency Department where diagnoses are made and acute management is given. In this case, the patient was referred to the Eye clinic from the Emergency Department for visual symptoms. Parinaud syndrome was promptly recognised by the ophthalmologist upon examination and the decision for urgent brain imaging with referral to the neurologist was quickly made. Timely management of patient likely contributed to his favourable outcome. Conclusion: This is a case of Parinaud syndrome secondary to an acute left posteromedial thalamic infact in a young person without obvious midbrain involvement. This case highlights the important role of ophthalmologists in the early recognition of Parinaud syndrome, which can allow for prompt diagnosis and management. Timely diagnosis of Parinaud syndrome can be crucial to patient’s outcome.