Venous infarction mimicking a neoplasm in spontaneous intracranial hypotension: an unusual cause of Parinaud's syndrome

Parinaud syndrome as an unusual presentation of intracranial hypotension

Background

Vertical gaze palsy is a rare clinical manifestation of intracranial hypotension. The typical features of intracranial hypotension include a postural headache, dural enhancement, and low cerebrospinal fluid (CSF) opening pressure.

Case Description

We describe a case of a shunt-dependent middle-aged female with aqueductal stenosis who developed recurrent presentations of upgaze palsy with postural headaches, confirmed low opening pressure, and slit ventricles on magnetic resonance imaging (MRI) due to shunt overdrainage. Her ophthalmoplegia and headaches improved following third ventriculostomy and with increasing the shunt opening pressure to prevent excess CSF drainage.

Conclusion

Intracranial hypotension should be considered part of the differential diagnosis for patients presenting with an upgaze palsy.