, Volume 61, Issue 5, pp 507–514 | Cite as

MRI findings in Parinaud’s syndrome: a closer look at pineal masses

  • Amrita-Amanda D. Vuppala
  • Nanki Hura
  • Sadaf Sahraian
  • Elham Beheshtian
  • Neil R. Miller
  • David M. YousemEmail author
Diagnostic Neuroradiology



The association between MRI findings in patients with pineal lesions and the presence or absence of Parinaud’s syndrome (PS) remains poorly described. We sought to better understand what MRI characteristics of a pineal lesion make PS more likely. Can these features predict prognosis for clinical resolution? Based on the anatomical relationship of the pineal gland and midbrain, we hypothesized that the degree of midbrain injury by a pineal mass as assessed by abutment, displacement, or intrinsic midbrain signal abnormality (IMSA) may predict PS.


We reviewed our institution’s databases to find patients with MRI evidence of an intrinsic lesion of the pineal gland. Seventy-seven patients with intrinsic pineal gland lesions, 26 with PS and 51 without PS (NPS), were identified. Data regarding clinical history were collected, and an experienced neuroradiologist reviewed all MRI studies and recorded mass size, midbrain abutment, displacement by the pineal lesion, and presence or absence of IMSA.


IMSA occurred with increased frequency in pineal lesions with PS (85%) when compared with NPS (39.2%) (p = 0.0001). Midbrain abutment, compression, and displacement occurred with similar frequencies in both groups, with no statistically significant difference. Hydrocephalus was present in 80.8% of patients with PS and 84% without PS (p = 0.75).


IMSA in a patient with an intrinsic pineal gland mass is associated with PS. Other findings such as hydrocephalus and midbrain displacement are common in patients with pineal masses both with and without PS and do not have any predictive value.


Parinaud’s syndrome Pineal mass Intrinsic midbrain signal Hydrocephalus Midbrain displacement 



Parinaud’s syndrome


No (without) Parinaud’s syndrome


Intrinsic midbrain signal abnormality


Compliance with ethical standards


No funding was received for this study.

Conflict of Interest

DY receives royalties from Elsevier, personal fees from Medicolegal consulting, speaker fees from ACR and other fees from Analytical Informatics.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

For this type of retrospective study formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Neurology and OphthalmologyUniversity of Nebraska Medical CenterOmahaUSA
  2. 2.Russell H Morgan Department of Radiology and Radiological SciencesJohns Hopkins HospitalBaltimoreUSA
  3. 3.Wilmer Eye InstituteJohns Hopkins HospitalBaltimoreUSA

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