Collier’s sign (Eyelid retraction) – It is the abnormal elevation of the upper eyelids and lowering of the lower eyelids.

The pupils respond well to near stimuli but they do not response to light.

Pseudo-Argyll Robertson pupils – The pupil of the patient is mid-dilated and demonstrates a light near dissociation.

The upward gaze mechanism is not functioning.

Upgaze paralysis – The patient complains of upward gaze palsy.

The clinical manifestations of parinaud syndrome include the following: Image Source: Parinaud Syndrome Symptoms Photo 2: A two year old patient with a clinical manifestation of parinaud syndrome. Image 1: A young adult with clinical manifestations of parinaud dorsal midbrain syndrome. He is the father of French ophthalmology. The term parinaud syndrome is named after Henry Parinaud, a French ophthalmologist. PMID 16845316.It is a term used to denote multiple eye abnormalities, specifically dysfunctional pupil and eye movement. Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society 26 (2): 134-8.

Loewenfeld, PhD Physiologist of the Pupil. Physiology, assessment, and disorders of the pupil. It is not known whether AR pupils are any different from the pupils seen in other dorsal midbrain lesions. This uncommon syndrome involves vertical gaze palsy associated with pupils that “accommodate but do not react.” The causes of Parinaud syndrome include brain tumors (pinealomas), multiple sclerosis and brainstem infarction.ĭue to the lack of detail in the older literature and the scarcity of AR pupils at the present time, it is not known whether syphilis can cause Parinaud syndrome. To settle the question of whether the AR pupil is of central or peripheral origin, it will be necessary to perform iris transillumination (or a magnified slit-lamp examination) in a substantial number of patients who have a pupillary light-near dissociation (with and without tonicity of the near reaction), perhaps in many parts of the world.Ī third cause of light-near dissociation is Parinaud syndrome, also called dorsal midbrain syndrome. The evidence supports a midbrain cause of the AR pupil, provided one follows Loewenfeld’s definition of the AR pupil as small pupils that react very poorly to light and yet seem to retain a normal pupillary near response that is definitely not tonic. Thompson and Kardon (2006) summarize the present view: It is not known whether neurosyphilis itself (infection by Treponema pallidum) can cause tonic pupils, or whether tonic pupils in syphilis simply reflect a coexisting peripheral neuropathy. tonic) that are necessary to distinguish AR pupils from tonic pupils. The older literature on AR pupils did not report the details of pupillary constriction (brisk vs. The exact relationship between syphilis and the two types of pupils ( AR pupils and tonic pupils) is not known at the present time. The accommodation pathways – pathways to the Edinger-Westphal nucleus that cause the pupils to constrict with near vision – are thought to be spared because of their more ventral course in the brainstem. These light-sensitive pathways allow the pupil to constrict to bright light. Specifically, the AR pupil is thought to be caused by selective damage to pathways from the retina to the Edinger-Westphal nucleus. The AR pupil is thought to be caused by damage to central pathways for pupillary constriction. Adie's pupil is caused by damage to peripheral pathways to the pupil (parasympathetic neurons in the ciliary ganglion that cause pupillary constriction to bright light and with near vision). The two different types of near response are caused by different underlying disease processes. The near response in tonic pupils is slow and prolonged. The near response in AR pupils is brisk and immediate. In the 1950s, Loewenfeld distinguished between the two types of pupils by carefully observing the exact way in which the pupils constrict with near vision. A patient whose pupil “accommodates but does not react” almost always has a tonic pupil, not an AR pupil. When penicillin became widely available in the 1940s, the prevalence of AR pupils (which develop only after decades of untreated infection) decreased dramatically. In the early 20th century, Adie described a second type of pupil that could “accommodate but not react.” Adie’s tonic pupil is usually associated with a benign peripheral neuropathy (Adie syndrome), not with syphilis.

The AR pupil became known as a reliable clinical sign of syphilis. When serological tests for syphilis became available, patients with AR pupils usually tested positive for syphilis. The AR pupil was named after Douglas Moray Cooper Lamb Argyll Robertson, a Scottish ophthalmologist who noted the association with syphilis in 1869.

Pseudo argyll robertson pupil paurinaud