Upper vision impairment

Introduction Pseudo-Parinaud syndrome is the most characteristic manifestation of nuclear damage, with complete oculomotor palsy and contralateral superiority. Confinement of the contralateral view is due to destruction of the rectus muscle on the lesion side. Should pay attention to the identification of vertical gaze, two ptosis with vertical gaze obstacles.

Cause

Destruction of the rectus muscle on the lateral side of the lesion. Paralysis of the two eyes in the same vertical vertical motion (Parinaud syndrome) is caused by lesions in the midbrain of the midbrain, often with pupil dilation and disappearance of photoreaction. A small number of patients are paralyzed in the same vertical movement. It causes some or all obstacles to the structure or function of the visual organs (eyeball optic nerve, brain visual center), and it is still unable to visually recognize the external things after treatment.

an examination

Related inspection

Electromyography eye and temporal examination CT examination of eye function

Nuclear damage: the oculomotor nucleus is a slender cell mass located around the cerebral aqueduct at the upper cerebral level of the midbrain. The bilateral top-down arrangement is to lift the iliac crest and the superior rectus nucleus. The inner rectus nucleus, the inferior oblique nucleus and the inferior rectus muscle nucleus are closely spaced on each side and the front and back are relatively far apart. Therefore, when the midbrain lesions are manifested as a single numbness of some of the bilateral eye muscles, the Edinger-wesphal nucleus at the front end is often not involved, so the pupil is more normal. The abductor nucleus is located at the level of the cerebral ventricle and is surrounded by the facial nerve. At the time of the lesion, the lesions in the same side of the eye can not be abducted, esotropia and peripheral facial paralysis, because the lesion often involves the same side of the non-intersecting pyramidal bundle.

Differential diagnosis

The symptoms of upper eye disorder in both eyes need to be identified as follows.

1 vertical gaze paralysis: the patient's random and reflex vertical gaze disappeared, which was caused by upper palsy in the anterior cranial infarction and posterior commissural infarction, and the medial and dorsal infarction of the red nucleus caused hypopharyngeal paralysis.

2 pseudo-Parinaud syndrome: is the most characteristic manifestation of nuclear damage, complete side of the oculomotor nerve paralysis with contralateral upper visual disorder. Confinement of the contralateral view is due to destruction of the rectus muscle on the lesion side.

3 Two ptosis with vertical gaze disorder: nuclear damage, the lesion involves the upper rectus muscle nucleus, the inferior rectus nucleus and the superior nucleus of the oculomotor nucleus, the inner rectus nucleus and the inferior oblique nucleus Not affected. Since the superior rectus nucleus and the inferior rectus muscle nucleus are located at the upper end of the oculomotor nucleus, they are first involved, and the nucleus of the iliac crest is singled, so some injuries will also cause the two ptosis to sag.

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