A thorough workup, including neuroimaging is essential to rule out anatomic lesions or other causes of this syndrome. Visually significant upgaze palsy can be relieved with bilateral inferior rectus recessions. Retraction nystagmus and convergence movement are usually improved with this procedure as well. Prognosis
The eye findings of Parinauds syndrome generally improve slowly over months, especially with resolution of the causative factor; continued resolution after the first 3–6 months of onset is uncommon. However, rapid resolution after normalization of intracranial pressure following placement of a ventriculoperitoneal shunt has been reported. References
Further reading
Aguilar-Rebolledo F, Zárate-Moysén A, Quintana-Roldán G (1998). "Parinauds syndrome in children". Rev. Invest. Clin. (in Spanish). 50 (3): 217–20. PMID 9763886. Waga S, Okada M, Yamamoto Y (1979). "Reversibility of Parinaud syndrome in thalamic hemorrhage". Neurology. 29 (3): 407–9. doi:10.1212/wnl.29.3.407. PMID 571990. S2CID 42247406. == External links ==
Subcortical dementias includes those diseases which predominantly affects the basal ganglia along with features of cognitive decline. Diseases such as progressive supranuclear palsy, Huntingtons chorea and Parkinsons disease are different in many features from the other cortical dementias like Alzheimers disease. Yet these patients present clinically with mild forgetfulness and slowed thought process along with abnormal movements and problems with motility. Clinical features
Clinically subcortical dementia usually is seen with features like slowness of mental processing, forgetfulness, impaired cognition, lack of initiative-apathy, depressive symptoms (such as anhedonia, negative thoughts, loss of self-esteem and dysphoria), loss of social skills along with extrapyramidal features like tremors and abnormal movements.In most of the patients with Huntingtons diseases the first clinical feature to appear is the change in personality. The dementia is more severe in patients with early onset of Huntingtons disease. Parkinsons disease is characterised by features of dementia in older age. The adult type "leukodystrophy" also causes subcortical dementia with prominent frontal lobe features. As a general rule the earliest symptoms in "cortical" dementia include difficulty with high-level behaviors such as memory, language, problem-solving and reasoning, mathematics and abstract thoughts – functions associated with the cerebral cortex. Such patients have prominent apraxia and agnosia. However, in "subcortical" dementia these high-level behaviours are less affected. Pathophysiology
In most common types of dementias there is widespread degeneration in the cerebral cortex – such as the plaques and neuro fibrillary tangles which are the hallmark of Alzheimers disease. In subcortical dementia, there is targeted damage to regions lying under the cortex.