Significance of upward gaze palsy (Parinaud's syndrome) in hydrocephalus due to shunt malfunction

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✓ Several cases are presented in which Parinaud's syndrome or upward gaze palsies were associated with hydrocephalus due to non-neoplastic aqueductal occlusion. In some of these cases the ocular signs proved to be an early and reliable indicator of increased intraventricular pressure due to shunt malfunction. The possible mechanisms by which this phenomenon occurs are discussed. The importance of differentiating such cases from those of neoplastic origin and the value of third ventriculography are stressed.

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Address reprint requests to: Ronald F. Shallat, M.D., East Bay Medical Group, Inc., 3000 Colby Street, Berkeley, California 94705.

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Figures

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    Pantopaque ventriculogram showing greatly enlarged suprapineal recess in Case 3 (left arrow), and occluded aqueduct (right arrow).

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    Highly cellular neoplasm with pseudo- and true rosettes. The cells have scanty cytoplasm with tapering processes and large nuclei containing coarse chromatin. Mitotic figures are numerous. H & E, × 430.

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    Drawing illustrating the anatomical relationships in the region of the mesencephalon.

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    Drawing showing aqueductal occlusion with expansion of the suprapineal recess and upper aqueduct resulting in tectal compression.

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