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Updated: Apr 17, 2026

Permanent Cerebral Vessel Occlusion via Double Ligature and Transection
Published on: July 21, 2013
Parinaud's syndrome due to an unilateral vascular ischemic lesion
Josefina Serino1, João Martins, Liliana Páris
1Department of Ophthalmology, Pedro Hispano Hospital, Rua Dr. Eduardo Torres, Senhora da Hora, 4464-513, Matosinhos, Portugal, juseserino@gmail.com.
Abstract:
A 59-year-old man who complained of binocular vertical diplopia after an exploratory laparotomy, complicated by cardiorespiratory arrest during anesthetic induction, was found to have Collier's sign, anisocoria, complete paralysis of upward vertical gaze associated with convergence-retraction nystagmus on attempted upgaze and skew deviation with hypertropia in the left eye without ptosis, and an absent Bielschowsky sign. Magnetic resonance imaging of the brain showed a small lesion in the left paramedian midbrain compatible with microvascular ischemic sequelae. This patient was diagnosed with Parinaud's syndrome (dorsal midbrain syndrome) associated with a vertical strabismus from an unilateral vascular ischemic paramedian midbrain lesion.
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Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above...