A Case of Parinaud Syndrome in a Patient with Parkinson's Disease: Causal Association or Co-incidental?

Background: Parinaud syndrome is a dorsal mid-brain syndrome characterized by upgaze paralysis, convergence retraction nystagmus, and pupillary light-near dissociation. Infarctions or hemorrhages involving the mid-brain are the most frequent causes in older adults. Objective: To report a novel case of a patient who presented with classical parkinsonian signs and Parinaud syndrome. Material and Methods: Patient data were obtained from medical records from the Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India. Results: A 62-year-old previously healthy man presented with motor and non-motor symptoms of Parkinson's disease (PD) for the past 6 years. The neurological examination revealed an asymmetric resting tremor of the upper limbs with rigidity, bradykinesia, hypophonia, hypomimia, decreased blinking, and micrographia. The neuro-ophthalmological examination showed Parinaud syndrome. He was treated with levodopa-carbidopa and trihexyphenidyl. After 6 months and 1 year of follow-up, his neurological condition was re-assessed; motor symptoms improved substantially, but Parinaud syndrome persisted. Conclusions: Parinaud syndrome can be a potential manifestation of PD. A detailed neuro-ophthamological examination should be carried out even in patients having a diagnosis of classic PD in whom eye-movement abnormalities are distinctly infrequent. [ABSTRACT FROM AUTHOR]