An unusual case of Parinaud's syndrome

Abstract

SummaryA 25-year-old man presented with blurred vision, headache and dizziness. On questioning, there was also a history of a preceding diarrhoeal illness. Initial investigations were normal. However, after a week, he represented with a Parinaud's syndrome. In view of the preceding diarrhoea, the transient unsteadiness and the areflexia on examination, anti-GQ1b antibodies were requested. The resulting titre was positive confirming the suspected diagnosis of Miller Fisher syndrome. He responded to intravenous immunoglobulins with full resolution of his symptoms and signs. Although various unusual neuro-ophthalmological signs have been reported localising to the brainstem, to our knowledge, this is the first case report of Parinaud's syndrome being the presenting symptom of Miller Fisher syndrome. BACKGROUND

Eyes wide open—an atypical presentation of Miller Fisher syndrome (MFS): case report

“…Both were diagnosed with Miller Fisher syndrome, on the grounds of concurrent ataxia and areflexia, normal brain imaging and positive anti-GQ1b antibodies. They both responded to intravenous immunoglobulin with full resolution of their symptoms and signs [11,12]. In the review of al-Din et al investigating the neuro-ophthalmic manifestations in Miller Fisher syndrome, 109 reports were included, describing 243 cases.…”

Posttraumatic Parinaud’s syndrome as a contrecoup injury in a case of closed head trauma

“…3 Encephalitis, demyelination, brain abscess, trauma, posterior tentorial herniation, and Wernicke's syndrome are rare causes of the syndrome. 4 The basic cause of PS is dependent on age. Neoplastic causes are more common in children and young adults, and vascular damage causes are more common in the middle-aged and older people.…”