Parinaud syndrome due to pineal vascular tumor in a pediatric patient: a case report
Keywords:
Parinaud's Syndrome; Vascular Tumor of the Pineal Gland; Precocious Puberty; Watchful WaitingAbstract
Introduction: Parinaud's syndrome, caused by a dorsal midbrain lesion, results in supranuclear palsy of vertical gaze. In pediatrics, pineal tumors are the main cause; vascular lesions are rare and pose a challenge to management due to high surgical risk. Endocrine manifestations such as precocious puberty are often underreported despite their diagnostic value.
Objective: to present a case of Parinaud's syndrome in a pediatric patient with an uncommon etiology (vascular tumor of the pineal gland).
Case presentation: a 10-year-old female patient presented with limitation of upward vertical gaze since age 6, precocious puberty (menarche at age 8), and inversion of the sleep-wake cycle since childhood. Ophthalmological examination confirmed supranuclear palsy of elevation, convergence-retraction nystagmus, and pupillary light-near dissociation. Magnetic resonance imaging identified a lobulated nodular lesion in the pineal gland (29 × 28 × 27 mm) with characteristics suggestive of a vascular tumor, without associated hydrocephalus. Given the high surgical risk and the four-year symptomatic stability, expectant management with active surveillance was chosen. After 18 months of follow-up, the patient remains clinically and radiologically stable.
Conclusions: Parinaud syndrome can present insidiously with incomitant vertical strabismus. Endocrine manifestations, such as precocious puberty, often precede oculomotor signs, suggesting a pineal etiology. In pineal vascular tumors with high surgical risk, expectant management with active surveillance is valid if symptoms are stable, although it requires indefinite follow-up due to the risk of bleeding.
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Copyright (c) 2026 Laura Isabel Moreno-Miña , Lissette Zuler Miña-Oliveros , Vivian Suárez-Herrera , Jaykel Martínez-Pujol
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