#Parinaud's

[mamaasawriter]

Le monde est aux mains d'une théorie de crapules qui veulent faire de nous des travailleurs spécialisés ; encore : refusons, Parinaud. Sachons tous.

Boris Vian, Je voudrais pas crever

[usmlecrusher-blog]

Parinaud’s Syndrome (Dr. Cole recommendation)

[tamsoj]

The man is fascinating, his success is glorious. After twenty years of devoted relationship I remain as curious about him as I was on the very first day.

André Parinaud on Salvador Dalí, from The Unspeakable Confessions of Salvador Dali

[neurologyteachingclub]

Parinaud's syndrome. For full discussion of the image hear ‘Clinical neurology with KD’ 🎙podcast episode 9. The link is given in the profile. A dorsal rostral midbrain lesion causes it. The vertical gaze palsy is due to the involvement of riMLF and the Interstitial nucleus of Kajal in the thalamo-midbrain junction. The lid retraction and convergence retraction nystagmus are due to the loss of supranuclear inhibition to the third nerve nucleus. The light near dissociation is due to damage of the pretectal nucleus or the decussating fibres of the pretectal nucleus in the posterior commissure. The pupillary reflex will be absent, while the accommodation reflex will be present. The accommodation reflex is preserved because the accommodation pathway enters the Edinger- Westphal nucleus more ventrally. #clinicalneurologywithkd #neurologyteachingclub #neurologypodcast #NTC #neurology #neurosciences #neuro #clinicalneurology #medicine #clinicalmedicine #kdpodcast #mbbs #medicos #doctors #neuroanatomy #casediscussion #medicineresidents #residency #medschool #futureneurologist #neuroimages #NEET #finalmbbs #neetpg #neetsuperspeciality #neetmedicine #eanneurology #nejm #aanbrain #neuroimage https://www.instagram.com/p/CcdZWYVvJfE/?igshid=NGJjMDIxMWI=

[doctorfoxtor]

surprise bitch. bet you thought you'd seen the last of me

100 days of productivity

day 23

CVS/RS

AS has the worst prognosis when associated with LVD (AS+AR has a poor prognosis but not as bas as AS+LVD)

in acute mitral regurgitation, tachycardia actually reduces the volume of the regurgitant jet (so don't give BBs/CCBs)

PEFR specifically works as an indicator for large airway disease

acute pericarditis, normal kidney function = give NSAIDs AND colchicine for 3 months (colch reduces the duration of NSAID tx); sub steroids if not tolerated/not effective

coarcts are associated w/ bicuspid aorta, NF1 and berry aneurysms (and ofc Turner's)

atrial myxoma can cause PUO, afib, middiastolic murmur, clubbing

WPW assoc w/ MVP, Ebstein anomaly, HOCM and thyrotoxicosis

CNS

dorsal midbrain (medial longitudinal fasciculus) → vertical eye movements

Parinaud syndrome = MLF insult: paralysis of upward gaze with convergence-retraction nystagmus on attempted upward gaze, light-near dissociation aka pseudo-Argyll-Robertson pupils, eyelid retraction, preference for downward gaze in neutral position, papilloedema

statins may be associated with increased risk of secondary bleed in ischaemic stroke → commence statin after 48 hours after symptom onset

meningococcal meningitis: benzylpenicillin > III gen cephalosporin > chloramphenicol

for ischaemic stroke affecting the proximal anterior circulation ONLY, consider thrombectomy either alone (if between 6-24 hours after symptom onset, including wake-up strokes, AND if parenchyma is salvageable) or with thrombolysis (if confirmed within 4.5 hours of symptom onset); thrombectomy can also be considered in proximal posterior circulation strokes but not as strong evidence

Endocrine

to prevent refeeding syndrome, give at most 50% of caloric requirement in the first two days

to prevent adrenal insufficiency, pts on long term steroids should *double* their doses in periods of intercurrent illness

Rheum/Derm

Still disease: nonbiologics → anti-TNFs → anakinra → rituximab

Sjögren's → assoc w/ Raynaud's, RTA, sensory polyneuropathy

monomorphic papular rash without vesicles, cysts or comedones on chest and back (esp. after starting roids) = drug-induced acne; withdraw offending drug

DILE: skin and pleural involvement are common, with possible myalgia, arthralgia; nephritis very uncommon

AnkSpon: syndesmophytes = ossification of annulus fibrosus

Schober test → locate L5 on patient's back; mark one point 5 cm below L5 and one 10 cm above; measure the distance between the two points; ask patient to touch toes with knees straight; measure the distance between the two points; positive test <5 cm of increase in the distance (sign of AxSpA)

GIT

PSC: 75% are assoc w/ IBD (either occurring before or after intestinal symptoms); also, more than 20% proceed to develop cholangiocarcinoma

IBS + iron/calcium deficiency, especially worse during or after pregnancy → HUGE red flag for coeliac

s/p needlestick w/ confirmed HCV+ pt's fluids, do monthly HCV RNA testing, and the moment it turns positive, slam them w/ IFN+ribavirin OR sofosbuvir-velpatasvir-voxilaprevir; if done quickly enough, has a >90% likelihood of cure

ulcerative colitis → goblet cell depletion on biopsy is specific

Onc/Haem

vocal cord palsy due to nerve invasion is a contraindication to resection of a Pancoast or thyroid tumour

shelf lives of blood products: platelets = 5 days; RBCs = 4-5 weeks; cryoprecipitate/PCC/FFP = 2 years

cryoprec is used to replace fibrinogen, indicated when serum fibrinogen <0.15 g/dl

hu painful is it? → anti-Hu = painful sensory neuropathy ± cerebellar signs (SCLC, sometimes neuroblastoma)

reflexes like a yo-yo → anti-Yo = cerebellar signs (ca ovary, ca breast)

ripid eye movements → anti-Ri = opsoclonus-myoclonus (neuroblastoma***, ca breast, SCLC)

purkipheral neuropathy → anti-Purkinje cell = peripheral neuropathy (ca breast)

muscle riGADity → anti-GAD = diffuse hypertonia (ca breast, ca colon, SCLC)

Renal/Biochem/Toxo

activated charcoal may be useful in aspirin poisoning beyond the described 1-hr point as aspirin absorption actually slows down when ingested in large quantities and persists in the gut for a long time

peritoneal dialysis peritonitis → CoNS (esp S. epidermidis) > S. aureus

Immuno

Neutrophils Love Cheddar Cheese → neutrophil disorders are Leukocyte adhesion deficiency, Chédiak-Higashi, Chronic granulomatous disease

Some Call B-cells Brutal → B-cell disorders are Selective IgA deficiency, Common variable immunodeficiency, Bruton's agammaglobulinaemia

diGeorge is a pure T-cell disorder (that may in turn lead to secondary B-cell dysfunction)

BuT Her Son WAS Ataxic → combined B/T-cell disorders are Hypermacroglobulinaemia, Severe combined immunodeficiency, Wiskott-Aldrich Syndrome, Ataxia-telangiectasia

in immunocompromise, give abx for otherwise 'benign' conditions anyway (eg, mild Campylobacter diarrhoea in a pt taking biologics—tx as if severe w/ macrolide)

[jjuune]

coney island (2020) / out of the woods (2014)

photos by Bob Parinaud

[mact-cact]

Alberto Giacometti "Notes sur les copies" Estratti di discussioni con Gotthard Jedlicka, Pierre Schneider, André Parinaud e Pierre Charbonnier. Éditions Fondation Giacometti Paris, 2016. ISBN 978-2-7356-9314-5. Donazione Andrea Fiori, Bellinzona, 2021. https://www.instagram.com/p/CbnAKqJMpMZ/?utm_medium=tumblr

[usmles1notes]

Children Brain Tumors

Most pediatric CNS tumors develop BELOW the tentorium cerebelli

INFRAtentorial CNS tumors can cause “cerebellar symptoms” (nausea/vomiting, gait problems, ataxia, impaired coordination)

INFRAtentorial tumors can cause obstructive HYDROCEPHALUS (due to obstruction of 4th ventricle)

Risk factors:

Exposure to ionizing radiation increases the risk of CNS tumors

Certain genetic syndromes increase the risk of pediatric CNS tumors (tuberous sclerosis, neurofibromatosis 1)

PILOCYTIC ASTROCYTOMA (named for “hairlike” projections on microscopy) (most common pediatric CNS tumor, almost always occurs in children)

Grade 1 (benign, unlike astrocytomas in adults [higher grade & aggressive])

Frequently contain activating mutations in the BRAF gene → activates abnormal cell growth

Well-circumscribed tumors; contain both solid and cystic components; composed of cells with long “hairlike” processes; long processes of tumor cells contain Rosenthal fibers (EOSINOPHILIC CORSKSCREW-shaped glial filaments)

Stains positive for GFAP (because they are glial tumors)

MEDULLOBLASTOMA (most common pediatric MALIGNANT CNS tumor)

Stain positive for SYNAPtophysin & NEURON specific enolase (because tumor originates from cells that are partially differentiated in the NEURONAL direction)

Can extend into the 4th ventricle (diamond-shaped CSF collection) --> intracranial hypertension (extension into 4th ventricle → obstructive hydrocephalus → ICH)

Some MEDULLOBLASTOMAS contain MYC amplifications

Soft friable tumors with areas of NECROSIS

Composed of sheets of small BLUE cells (due to hyperchromic nuclei and scant cytoplasm)

Homer-Wright ROSETTES (small BLUE cells surrounding acellular pink neuropil)

May produce “DROP metastases” (CSF contains malignant cells, tumor nodules form along spinal cord)

Ependymoma

CNS tumor that arises from cells lining the VENTRICULAR system [ependymal cells]

Most commonly grow from the roof of the 4th ventricle (diamond-shaped CSF collection) --> intracranial hypertension (extension into 4th ventricle → obstructive hydrocephalus → ICH)

In adults & neurofibromatosis type 2, EPENDYMOMAS occur along the SPINAL cord

Well-circumscribed tumors; contain both solid and cystic components; display PERIVASCULAR pseudorosettes (cells form a circle around blood vessels → grow long extensions toward the center); display ependymal rosettes (cancer cells cluster in an attempt to form a ventricle → ring of cells around an empty lumen)

Craniopharyngioma

Benign tumors arising from epithelial remnants of Rathke’s pouch [oral ectoderm that ultimately forms anterior pituitary] (most common SUPRAtentorial pediatric tumor)

Display solid, cystic, and calcified components

Primary CNS GERM cell tumors (extragonadal GERM cell tumors, result from abnormal migration of embryonal cells during development)

Pinealoma

The PINEAL gland is the most common location for CNS germ cell tumors (PINEALOMAS)

Primary CNS germ cell tumors are most commonly GERMINOMAS (similar to testicular SEMINOMAS)

Can cause obstructive HYDROCEPHALUS (due to impingement on cerebral aqueduct)

Can cause intracranial hypertension (due to obstructive hydrocephalus)

Can lead to Parinaud syndrome (vertical gaze palsy syndrome, presents with “setting sun sign”) (due to compression of the tectum & superior colliculi)

[dead-molchun]

Salvador Dali (1904-1989) From 'Andre Parinaud, After 50 Years Of Surrealism, Fribourg, Switzerland, Transworld Art, 1974' (680 x 544mm)

[bunniesandbeheadings]

Insignia and medals on gilded bronze awarded to Bastille conquerors. From The French Revolution in Paris: Seen Through the Collections of the Carnavalet Museum, Jean Tulard and Marie-Hélène Parinaud, Paris-Musées, 1989.

[alainlesourd-14]

Roger NIMIER

Bengt LINDSTROM

Paméla eut le tort de répéter sa phrase

Association des cahiers Roger Nimier, Paris 1986, 25,5x33cm, en feuilles sous coffret.

Edition originale imprimée à165 exemplaires numérotés sur vélin d'Arches.

Chemise-coffret en pleine toile indigo, dos lisse.

Dos et plats légèrement et marginalement décolorés sans gravité.

Agréable et rare exemplaire.

Notre exemplaire comporte bien sa lithographie originale en cinq couleurs par Bengt Lindström qu'il a signée.

Signature manuscrite d'André Parinaud, président de l'association des cahiers Roger Nimier, au colophon.

Agréable et rare exemplaire.

https://www.edition-originale.com/fr/litterature/editions-originales/nimier-pamela-eut-le-tort-de-repeter-sa-1986-62140?id_recherche=5d39bf9e2172f

[photosworthseeing]

# 10146 : Crushed by Bob Parinaud

Montréal, Qc.

Thank you for your submission! We love it!

PWS - Photos Worth Seeing

[burningladywitch]

Parinaud Syndrome Definition, Symptoms, Causes, Treatment

Parinaud Syndrome Definition, Symptoms, Causes, Treatment

Learn all about Parinaud syndrome definition, symptoms, causes and treatment options.

Parinaud’s Syndrome is a cluster of abnormalities of eye movement and pupil dysfunction. Named after Henry Parinaud, a French ophthalmologist (1844-1905) considered to be the father of French ophthalmology. The dorsal midbrain syndrome is also known as Parinaud’s syndrome, sylvian aqueduct syndrome, or pretectal…