Parino Syndrome

Neurological diseases with violation of eyeball movements are Parino syndrome. Let's consider features of the given pathology, methods of diagnostics and treatment.

According to the international classification of diseases of the ICD 10, the disorder belongs to the category VI Diseases of the nervous system (G00-G99):

• G40-G47 Episodic and paroxysmal disorders
• G46 * Vascular cerebral syndromes in cerebrovascular diseases (I60-I67 +)
• G46.3 Parino Syndrome

The syndrome is included in the category of pathologies associated with dysfunction of the pupils and violation of eye movement. The disease is named in honor of the father of French ophthalmology - Henri Parino. Paralysis of the vertical gaze is a bilateral ptosis of the eyelids, a sluggish reaction to or lack of convergence, as well as narrow pupils. It is observed in vascular diseases, epidemic encephalitis. Patients are diagnosed with miosis, disequilibrium, simultaneous movements of eyeballs are limited.

[1], [2], [3]

Epidemiology

The pattern of development of the spinal midbrain syndrome is associated with the presence of pathologies that can provoke it. Epidemiology points to such groups of patients:

• People under 40 years with tumorous neoplasms in the middle brain or pineal gland.
• Women 20-30 years with multiple sclerosis.
• Patients of advanced age after stroke of the upper brain.

To reduce the level of morbidity, it is necessary to reduce the risk of developing pathological conditions that cause impaired movement of the eyeball.

[4], [5],

Causes of the Parino syndrome

There are several causes of Parino syndrome, consider them:

• Spinal cord injuries
• The defeat of the long branches of the posterior cerebral artery
• Myositis of oculomotor muscles
• Defeat of the midbrain, posterior spike of the diencephalon
• Displacement of the cerebral hemispheres in the opening of the cerebellum nestle
• Ischemic injury or compression of the midbrain

Very often the disease occurs in tumors of the pineal gland, which proceeds with squeezing the center of the vertical view in the interstitial rostral nucleus of the longitudinal medial fascicle. In some patients, the disease is diagnosed after suffering jaundice, Nyman-Pick disease, Wilson disease and barbiturate overdose.

Pathology is part of the structure of mesencephalic syndrome (displacement stage) and can occur simultaneously with flaccid pupillary reactions with a vertical nystagmus. In rare cases, the disorder provokes hemorrhages in the middle brain, cerebral arteriovenous malformation, obstructive hydrocephalus, toxoplasmosis or traumatic infectious disease of the brain stem. Neoplasms of the posterior cranial fossa and aneurysms may also be associated with supranuclear palsy of associated eye movements.

[6], [7], [8]

Risk factors

Doctors identify certain risk factors that can provoke the Parino syndrome, consider them:

• Tumor lesions of the pituitary gland.
• Metastatic tumors.
• Hydrocephalus and dysfunction of the shunt in hydrocephalus.
• Disorders of the central nervous system.
• Hypoxia.
• Neurosurgical trauma.
• Syphilis.
• Tuberculosis.
• Multiple sclerosis.
• Lipidosis.
• Deficiency of vitamin B12.

In some cases, the limitation of the gaze upward provokes Parkinson's disease, Wernicke's encephalopathy, Fisher's syndrome and Lambert-Eaton syndrome, as well as other pathologies with similar symptoms.

[9], [10], [11]

Pathogenesis

The mechanism of development of paralysis of the vertical gaze completely depends on the cause of its origin. Pathogenesis can be associated with stem encephalitis or develop against a background of hydrocephalus, a tumor of the quadruple, a pituitary or an epiphysis. Paralysis is characterized by a violation of the transmission of signals from the brain to the eye.

If the pathological condition is based on the lesion of the prefectural area, then the development of the Vincent-Alauganin syndrome in combination with Argyll's syndrome and Robertson syndrome is possible. Violation of the eyeball upward movements is accompanied by bilateral paralysis of the oculomotor nerves and paralytic mydriasis.

[12], [13]

Symptoms of the Parino syndrome

The clinical symptoms of the Parino syndrome are manifested by the upward glare in combination with the paralysis of convergence (convergence). Pupillary reactions are also possible. These signs may indicate the displacement of the cerebral hemispheres in the aperture of the cerebellum.

The main symptoms of supranuclear palsy associated eye movements:

• Paralysis of the upper glance.
• Removal of eyelids.
• Conjugation of the view down in the preferred position.
• Violation of equilibrium.
• Bilateral edema of the optic nerve.
• Pseudo-pupil of Argyle Robetson (accommodative paralysis, pupils dilated, dissociation brightly close).
• Convergence-retraction nystagmus (may develop due to attempts to look up) ..

If the disease has an innate character, then there is hypertensive-hydrocephalic syndrome, that is, an increase in the size of the skull, divergence of seams and damage to the cranial nerves, delay in development (physical, mental), decreased motor activity of the hands and feet.

First signs

Symptoms of mesencephalic syndrome largely depend on its cause. The first signs of the Parino syndrome, caused by a tumor neoplasm, are as follows:

• Morning headaches and dizziness.
• Nausea and vomiting.
• Doubling in the eyes.
• Decreased visual acuity and hearing.
• Increased weakness.
• Impaired sensation in one half of the body.
• Increased drowsiness.
• Change in body weight.
• Epileptic seizures.
• Hypertensive hydrocephalic crises.

Against the background of the above described symptoms, the pupils' reaction to light and the convergence with accommodation are weakened. The pupil does not change, anisocoria is possible. Gradually, the vertical paresis of the gaze is developing. There may also be pathological retractions of the upper eyelids. When viewed directly visible white strip of sclera between the edge of the eyelid and the limb of the cornea and their trembling. Possible ataxia, abnormal breathing, altered consciousness and rapid involuntary contractions of the muscles of one half of the body, i.e. Hemitremor.

[14], [15], [16]

Stages

Neurological disease, characterized by paralysis of the eye, has several types and stages.

Stages of Parino syndrome:

• Early - violation of neurological functions, which are controlled by the cortex and the interstitial brain. The severity of the pathological symptoms depends on the degree of residual preservation of the cerebral cortex and the diencephalic reticular formation. Most often, patients face respiratory disorders, sleep disorders and general weakness. Pupils are small, they react to light. The motor reactions to stimuli depend on the localization and prevalence of the primary lesion.
• Diencephalic is the defeat of the midbrain and bridge. At this stage, the development of a coma is possible. Breathing normalizes, becomes smooth and regular. Pupils are of medium size, but do not respond to light. Eye movements are unfriendly, oculocephalic and oculo-vestibular reflexes are possible.
• Decerebration is a feature of this stage, this is its spontaneous development. Breathing slows down and becomes irregular. Pupils are of medium size, do not respond to light, there are no reflex movements of the eyes. Gradually develops flexor hypertension in the legs, extensor muscle hypertension decreases.
• Terminal - this is the last stage, on which the defeat of the medulla oblongata occurs. Breathing is difficult and slow. Heart rate and blood pressure change. Because of tissue anoxia, the pupils dilate. Without active resuscitation, serious brain damage occurs, and a lethal outcome is possible.

Depending on the stage of supranuclear paralysis of associated eye movements, the methods of its diagnosis and treatment depend.

[17],

Forms

Paralysis gaze up in combination with a violation of eye convergence and spasms of the eyeballs - this is the Parino syndrome. Types of disorders depend on the degree of damage, that is, the prevalence of the pathological process:

• Paralysis of the horizontal gaze (defeat of the frontal lobe of the brain).
• Paralysis of the vertical gaze (affection of the midbrain or the pathways to it).

Most often the disease develops because of the tumor of the pineal gland. This is manifested by the upward gaze, the violation of pupillary reactions and the paralysis of convergence. With the progression of pathological symptoms, there are displacements with oculomotor disorders (ptosis, limitation of mobility of eyeballs). In the future there is compression of the brain stem cover, which manifests as a violation of the tone in the limbs, hyperkinesia, intentional tremor.

If the bias increases, then there are symptoms of mesencephalic-pontine and pontinulo-bulbar syndromes, cerebellar and occlusive-hydrocephalic syndromes. With further progression, symptoms of parkinsonism and supranuclear ophthalmoplegia are possible.

Complications and consequences

If treatment of Parino syndrome was started too late or therapy was ineffective, then its various consequences and complications are possible. This manifests itself as signs of a malfunction in the midbrain. 8% of patients develop diabetes insipidus, which is caused by the downward punching of the pituitary foot and the mid elevation of the hypothalamus.

Most often observed pronounced abnormal fluctuations in body temperature, hyperthermia can be dramatically replaced by hypothermia. Superficial rare respiratory movements are gradually aggravated, they become more frequent and pass into tachypnea. With further progression and brain damage, a lethal outcome is possible.

[18], [19], [20], [21], [22]

Diagnostics of the Parino syndrome

Based on common signs, which are determined visually, the diagnosis of Parino syndrome occurs. The doctor prescribes a comprehensive clinical examination aimed at excluding anatomical disorders and other causes of the neurological condition.

Diagnosis largely depends on the cause of the disorder. If the disorder is associated with craniocerebral trauma or neoplasm in the brain, then use a variety of instrumental techniques, in conjunction with laboratory research. If the paralysis of the vertical view is combined with the parezes of a downward glance, the patient is diagnosed with the syndrome of the sylvian aqueduct and conducts appropriate diagnostic procedures.

[23], [24], [25]

Analyzes

The laboratory diagnosis of Parino Syndrome consists of a clinical analysis of blood and biochemistry, studies to identify rheumatoid and myositis-specific antibodies, urine, stool and other biological fluids. Analyzes are necessary to identify possible causes of a pathological condition and a comprehensive examination of the body.

In spinal cord injuries, an analysis of cerebrospinal fluid and the study of somatosensory potentials are performed. If there is a suspicion of oncology, then an analysis for cancer markers is shown. Also, laboratory tests are performed to identify the infectious causes of oculomotor disorders.

[26], [27], [28], [29]

Instrumental diagnostics

The most common cause of spinal cord syndrome is the pineal gland. To identify them use different methods of instrumental diagnostics, consider them:

• Computer tomography - using X-rays receive layered pictures of affected areas of the body.
• Magnetic resonance imaging - non-invasive imaging of the tumor and evaluation of the severity of damage to the brain tissue.
• Electromyography and electroneurography is the evaluation of the electrical activity of muscle tissue and the determination of the speed of electrical impulses along nerve fibers.
• Lumbar puncture is the sampling of cerebrospinal fluid with their subsequent study on atypical cells (malignant process).

In addition to the above-described studies, the following can be prescribed: pneumomielography, myelography, ventriculography, echoencephaloscopy. All the diagnostics are under the control of a neurologist.

Differential diagnosis

There are many neurological diseases, the symptoms of which are similar to those of paralysis of the vertical gaze. Differential diagnosis is carried out to separate the true pathology from similar disorders.

The differentiation of the Parino syndrome is carried out with such diseases:

• Systemic vasculitis.
• Tumors of the orbit and base of the skull.
• Phlegmon orbit.
• Aneurysm of the carotid artery.
• Aneurysm of the arteries of the Willis circle.
• Stem encephalitis.
• Malignant exophthalmos.
• Likvornaya hypertension.
• Oculopharyngeal muscular dystrophy.
• Metastases in the orbit of lung cancer or mammary glands.
• Temporal arteritis.

Neurological disorder is compared with the phenomenon of "pupal eyes", when the patient can not follow the moving object, but can fix the look on the subject and passively tilt, turn the head. If there is a suspicion of the phenomenon of Bell, then supranuclear vertical paralysis of the eyes is observed.

[30], [31], [32], [33], [34], [35],

Treatment of the Parino syndrome

Violation of the eyeball upward movements does not have specific therapy. Treatment of Parino syndrome is aimed at eliminating the cause, if possible, of causing it. That is, the whole emphasis is on the etiology of the disease. If the disorder is of an infectious nature, then massive antibiotic therapy in combination with corticotherapy is indicated. In case of tumor invasions, X-ray therapy and surgery are performed.

If the disorder is associated with the injuries received, then surgical intervention is possible. The patient undergoes a bilateral recession of the lower rectus muscle, which frees the upper view, improves the convergence movement and retraction of the nystagmus. Treatment is supplemented by the intake of vitamin complexes and physiotherapy.

Medications

The treatment plan and choice of drugs for Parino syndrome depends entirely on the cause of the disease. Medicines are chosen by the attending physician, based on the anamnesis and etiology of the pathological condition.

1. Spinal cord injuries - drugs are selected, focusing on the nature of damage. As a rule, these are broad-spectrum antibiotics (Amoxicillin, Tetracycline, Ciprofloxacin, Chloramphenicol), with spinal shock, Dopamine and Atropine are used. To eliminate the effects of hypoxia of the brain, Diphenin, Relanium and Vitamin E.

• Amoxicillin

Bactericidal antibiotic of a broad spectrum of action from the group of semisynthetic penicillins. It is used for various inflammatory lesions and for them. It has several forms of release (tablets, capsules, solution for oral administration, suspension, powder for injection). Dosage and duration of therapy depend on indications for use. Side effects are manifested in the form of allergic reactions (hives, swelling, conjunctivitis), joint pain and development of superinfection are possible. The main contraindication is an increased sensitivity to penicillins, pregnancy, a tendency to allergic reactions.

• Dopamine

It is used for shock conditions of various etiologies. Improves hemodynamics in vascular insufficiency and other pathological conditions. Used intravenously drip with a solution of glucose or isotonic sodium chloride solution. Side effects can cause heart palpitations, ischemia, arrhythmia. Contraindicated to use in diseases of the thyroid gland, tumor lesions of the adrenal gland, heart rhythm disturbances.

• Relanium

It is prescribed to eliminate convulsive conditions of various etiology, acute psychomotor agitation, neurotic and neurosis-like disorders. Has several forms of release, which determine the way of application. Depending on the patient's condition, the doctor prescribes the dosage and course of treatment. Contraindications: myasthenia gravis, angle-closure glaucoma, shock state. Overdosing manifests itself in the form of oppression of consciousness of varying severity, lowering blood pressure, and increased drowsiness. To eliminate this condition, symptomatic therapy and gastric lavage are indicated.

2. Myositis of the oculomotor muscles - symptomatic therapy with anti-inflammatory NSAIDs (Analgin, Ibuprofen, Akamizone) and pain medications (Ibuklin, Tempalgin) is indicated. Also possible use of antibiotics, corticosteroids and immunosuppressors.

• Diclofen

A derivative of phenylacetic acid with anti-inflammatory and analgesic properties. It is used for inflammatory and degenerative diseases of the musculoskeletal system, expressed pain syndrome, algodismenore, infectious and inflammatory defeats of the body. The drug is taken by 25 mg 2-3 times a day, the duration of treatment is determined by the doctor. The drug is contraindicated in case of hypersensitivity to its components, aspirin triad, blood clotting disorders, during pregnancy and erosive and ulcerative gastrointestinal lesions. Adverse reactions are manifested by adverse symptoms from all organs and systems. Most often, patients face allergic reactions, nausea, vomiting, dizziness, increased drowsiness.

• Spazmalgon

Combined analgesic with a pronounced antispasmodic effect. It is used in severe pain syndrome caused by spasms of smooth muscles and painful sensations of another etiology. The drug is released in the form of tablets for oral administration. For treatment appoint 1-2 tablets 2-3 times a day, but not more than 6 tablets a day. Side effects are manifested by disorders of the gastrointestinal tract, nausea and vomiting, pain in the epigastric region. Also possible allergic reactions, increased blood pressure, headaches, difficulty urinating. Spazmolgon is contraindicated in case of intolerance of its components, suspicions of surgical pathologies, violation of the hematopoiesis system, severe renal / hepatic insufficiency.

3. Multiple sclerosis - treatment of the disorder of the spinal cord and the brain is complex and quite lengthy. Ophthalmic disorders of varying severity can occur at all stages of the disease. For the treatment of drugs used to stop the progression of pathology: Dexamethasone, Prednisolone, ACTH, and others.

• Dexamethasone

Glucocorticosteroid with anti-inflammatory and antiallergic properties. It is used with a sharp drop in blood pressure, a shock state after trauma or surgical intervention, with severe infectious lesions, allergic conditions. Dosage is individual for each patient, as a rule, the drug is taken 10-15 mg 1-2 times a day. Side effects: nausea, dizziness, oppression of consciousness, allergic reactions.

• Novantron

Antitumor agent. It is used for multiple sclerosis at all stages, oncological lesions of the breast, non-Hodgkin's lymphoma, leukemia. It has several forms of release, the dosage depends on the indications for use and the doctor's recommendations. The drug is contraindicated in case of hypersensitivity to its components, during pregnancy and lactation, acute myocardial infarction, angina pectoris, infectious diseases. Side effects are manifested in the form of oppression hemopoiesis, disorders of the digestive system. Allergic and local reactions are possible. Treatment is symptomatic.

4. Stroke stroke - drug therapy is used as an auxiliary, since the main emphasis is on surgical intervention. From medicines such preparations can be appointed or nominated: Flunarizinum, Nimodipinum.

• Flunarizine

A drug that relaxes smooth muscles and blocks calcium channels. Improves cerebral circulation, reduces the severity of vestibular disorders. Has antihistamine and anticonvulsant action. It is prescribed for dizziness due to cerebral circulation disorders and vestibular disorders. The drug is taken 10 mg once a day. Side effects cause drowsiness, extrapyramidal disorders, changes in body weight.

• Nimodipine

Antagonist of calcium ions, affects the blood supply to the brain and reduces hypoxic phenomena. It is used to treat and prevent ischemic impairment of cerebral circulation. Dosage and duration of treatment depend on the severity of the pathological condition. Possible side effects: hypotension, headaches and other dyspepsia. The drug is contraindicated for use in pregnancy, brain edema, impaired renal function and acute increase in intracranial pressure.

5. Tumors in the middle brain or pineal gland are surgical treatment, in combination with radiation therapy and medicines. Patients are prescribed anti-inflammatory and analgesic agents - ketofen, antidepressants - amitriptyline, antipsychotic and diuretic drugs - haloperidol, hydrochlorothiazide and other medications.

• Amitriptyline

Tricyclic antidepressant with a pronounced sedative and timoanaleptic effect. It is used in depressive states, anxiety-depressive and emotional disorders, neurogenic pains and for the prevention of migraine. The drug is taken orally at 50-75 mg per day in 2-3 divided doses. Side effects provoke increased intraocular pressure, dry mouth, constipation, fever, headaches, increased weakness. Overdose is manifested by increased side reactions, for its elimination, it is necessary to stop therapy. Antidepressant is contraindicated in heart failure, arterial hypertension, ulcerative lesions of the gastrointestinal tract, impaired conduction of the cardiac muscle.

• Haloperidol

Neuroleptic with antipsychotic effect. It is used for delusions, hallucinations, acute and chronic psychoses, as well as for the complex treatment of pain syndrome. The drug is taken at 150-300 mg per day, with intramuscular and intravenous administration, 0.4-1 ml of a 0.5% solution is indicated. Side effects are manifested in the form of extrapyramidal disorders and insomnia. The drug is contraindicated in cases of organic lesions of the central nervous system, violations of cardiac conduction and kidney disease.

All of the above drugs are used only for medical purposes and after establishing the true cause of vertical paralysis.

Vitamins

Supranuclear paralysis of associated eye movements requires comprehensive treatment. Vitamins are prescribed in conjunction with the main therapy of the disease that caused the Parino syndrome. Vitamin preparations are needed to strengthen the eye muscle and restore its work. Eyes are necessary as fat-soluble (A, E, D), and water-soluble (C, B) vitamins.

• A - retinol is a component of the visual pigment, which converts light that enters the nerve impulses on the retina. Deficiency of this substance affects the visual acuity and reduces the protective properties of the immune system.
• E, D - tocopherol is used for myopia, as it minimizes the risk of detachment of the retina. Calciferol improves calcium absorption and is necessary for normal muscle contraction.
• C - ascorbic acid strengthens the walls of the blood vessels of the eyes and improves its blood supply. Used to prevent cataracts, reduce eye strain and fatigue.
• Group B - vitamin B1 takes part in the transmission of nerve impulses in the eye nerves and the formation of an intraocular pressure reducing enzyme. B2 is part of the visual pigment and protects the retina from UV radiation. B3 improves the blood supply to the eye by lowering blood cholesterol, regulates higher nervous activity. B6 relieves tension from the eyes, prevents disorders and inflammation of the optic nerve. B12 improves the condition of the optic nerve, it is used as a preventive measure of glaucoma.
• Lutein - strengthens the lens and retina, protects against pathological changes, supports the normal functioning of the eye. Suppresses the formation of free radicals, reflects a harmful blue color, improves the indices of neurons in the central zone of the retina. Increases visual acuity, has antioxidant properties.
• Anthocyanins are anti-inflammatory compounds and antioxidants that protect against retinopathy. The substances strengthen the walls of the blood vessels of the retina and promote the removal of lipofuscin from the eye tissues.
• Zinc - a deficiency of this mineral disrupts the absorption of glucose by the lens of the eye and can lead to the development of cataracts.
• Omega - 3 - improves the nutrition of the eyeball, supports retinal health, prevents inflammation.
• Selenium removes oxidation products from the body and stops the age-related destruction of the visual apparatus. Protects the eye tissue from oxygen radicals.
• Copper - this microelement is part of the enzyme antioxidant defense of the body. Improves the absorption of iron, which is necessary for the synthesis of hemoglobin. Accelerates the oxidation of vitamin C and takes part in the healing processes.
• Potassium - improves blood flow to the organs of vision, fights with eye fatigue.

All the above vitamins and minerals are present in food. There are also specialized dietary supplements and nutritional supplements, which are useful for oculomotor disorders.

Physiotherapeutic treatment

Violations of eyeball movements of any severity require complex therapy. Physiotherapeutic treatment of Parino syndrome is aimed at strengthening the muscle, which is responsible for the movement of the organs of vision. The patient is prescribed:

• Massage.
• Pharmacopuncture.
• Hirudotherapy.
• Paraffin-ozocerite and mud applications.
• Magnetotherapy.
• Laser therapy.
• Physiotherapy.

Physiotherapy is used in the initial stages of the disorder, for its prevention and reduction of pathological abnormalities. But, without medication the exercises will not help to eliminate the violations.

Alternative treatment

Treatment of the spinal midbrain syndrome completely depends on the reasons that triggered it. Alternative treatment is used for light injuries of the eye muscles, which are not associated with severe pathological processes in the body.

Consider the popular recipes for the treatment of paresis of eye movement:

• If paralysis is associated with Parkinson's disease, which has appeared against the background of cerebral artery atherosclerosis, it is recommended to take the juice and fruits of feijoa. This plant leads to a persistent improvement.
• A teaspoon of dried peony roots pour 250 ml of boiling water, wrap and let it brew for 1 hour. Once the infusion has cooled, it must be filtered and taken 1 tablespoon 3 times a day for 20 minutes before meals. Medicinal properties is possessed by an alcoholic tincture of the peony (drugstore), which is taken on 30-40 drops 3 times a day.
• A teaspoon of leaves of sumac, pour 250 ml of boiling water and let it brew for an hour. The drug should be filtered and take 1 tablespoon 3-4 times a day.
• Two teaspoons of herbs Voroniki pour 250 ml of boiling water, cook over low heat and let it brew for 2 hours. After cooling, strain and take 1/3 cup 3 times a day.

Before using untraditional methods of treatment, it is necessary to consult with the attending physician.

[36]

Herbal Treatment

If the Parino syndrome is associated with pathologies on the part of the central nervous system, many patients resort to treatment with herbs. This method is effective in the event that the weakening of motor functions and the reduction of the muscular forces of the eyes is associated with disorders of the nervous system.

• One tablespoon of the snakehead, pour 250 ml of boiling water and let it sit for 2-3 hours. Take 3 tablespoons 2-3 times a day before meals. If desired, you can add a spoonful of honey to the medicine.
• Two teaspoons of dry herbs Marin root pour 250 ml of boiling water and leave for 1-2 hours. After cooling, strain, and take before eating 1/3 cup 2-3 times a day. This recipe is effective in the defeat of nerve fibers and paresis.
• If the disorder is of an infectious nature, then you can use the fresh grass of the porcloak garden. Pour 1 tablespoon of vegetable raw material 250-300 ml of boiling water and leave for 2 hours. Means take 2-3 tablespoons before meals 3-4 times a day.
• 5 g of tobacco leaves pour 250 ml of boiling water and let it brew for 1 hour. After cooling, the infusion should be filtered and taken 1 tablespoon 2-3 times a day. If desired, you can add a spoonful of honey to the medicine.

To prevent possible allergic and other adverse reactions, you should consult your doctor before using the above prescriptions.

Homeopathy

An alternative treatment for many diseases is homeopathy. When paralysis of the vertical gaze is recommended such means:

• Gelseminum - is used for paralysis of the eye muscles and for paresis of the pectoral muscles.
• Causticum - used for all kinds of paresis. The drug can be taken in conjunction with other drugs.
• Kalium jodatum - effective for paralysis of the eye's nerve.
• Mercurius jodatus flavus - oculomotor disorders of any etiology, complete paralysis of all eye fibers.

The above preparations can be taken only by the prescription of a homeopath physician, who selects the medication and its dosage for each patient individually. As a rule, funds are taken in a 30-fold dilution to reduce pathological symptoms.

Operative treatment

If the Parino syndrome has a tumor origin, then surgical treatment is indicated. Surgical intervention is performed in severe spinal cord injuries, brain damage and other neurosurgical pathologies.

Most often, the operation is performed with tumors of the pineal gland, which squeezes the center of the vertical view, causing paralysis of the eye. Such treatment is complemented by radiotherapy and chemotherapy, which is aimed at the destruction of malignant cells. If the oculomotor disorder is associated with a stroke, then the operation is not performed. Therapy is aimed at restoring some functions of eye control.

Prevention

Prevention of the development of oculomotor disorders is based on the prevention of diseases that can cause paresis. Prevention of Parino syndrome consists of:

• Timely treatment of infectious and any other diseases.
• Observance of safety measures in all conditions to prevent injuries to the spinal cord or brain.
• Refusal from bad habits: smoking alcohol.
• Compliance with a healthy, fractional diet.
• A healthy lifestyle and regular exercise.
• Vitaminotherapy.
• Control of blood pressure.
• Regular preventive examinations at the doctor.

The abovementioned preventive recommendations will minimize the risk of developing supranuclear paralysis of associated eye movements.

[37]

Forecast

The outcome of vertical paralysis depends on the severity of lesions, their nature and etiological factor. The prognosis of the Parino syndrome varies considerably. Depending on the nature of the pathological condition, recovery can occur quickly or not at all.

For example, inflammatory diseases are treated for several months. While patients with ischemic optic neuropathy may forever remain with a narrowed gaze upward. With traumatic lesions of the brain or spinal cord, ventriculoperitoneal bypass surgery is possible to stabilize intracranial pressure.

The Parino syndrome requires a comprehensive diagnosis and an integrated approach to treatment. The earlier the cause of the disorder is established, the higher the chances of eliminating the disorder and minimizing its pathological complications.

[38], [39]