Abstract

Parinaud syndrome is classically described by the triad of upgaze palsy, convergence retraction nystagmus, and pupillary hyporeflexia with light near dissociation. A 17-year-old male with a pineal germ cell tumor presented to us after craniotomy and debulking with diminution of vision in both eyes with inability to elevate both eyes for 3 months. On examination both eyes were fixed in downgaze with counting fingers close to face vision. There was -4 restriction in elevation in both eyes. On attempted elevation convergence retraction nystagmus was noted. Collier sign was positive. Both pupils were widely dilated with light near dissociation. This video shows these classical features clearely. He was diagnosed with Parinaud’s dorsal midbrain syndrome with cortical visual impairment. He has received 4 cycles of chemotherapy and whole ventricular irradiation and on follow up there is minimal improvement in vision and elevation.