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1) what is the sign shown below ? 2) what is the diagnosis? 3) what are the features of this condition? 4) how will you manage the case? #LearningwithVisuals

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Sunset sign phenomenon The setting-sun phenomenon is an ophthalmologic sign in young children resulting from upward-gaze paresis. In this condition, the eyes appear driven downward, the sclera may be seen between the upper eyelid and the iris, and part of the lower pupil may be covered by the lower eyelid. Pathogenesis of this sign is not well understood, but it seems to be related to aqueductal distention with compression of periaqueductal structures secondary to increased intracranial pressure. A CT scan may shiw hydrocephalus . An external ventricular derivation may be needed. Immediately after the procedure, the fontanelle became flat, the setting-sun sign disappeared, and the child can become more alert and started focusing.

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Sunset sign phenomenon The setting-sun phenomenon is an ophthalmologic sign in young children resulting from upward-gaze paresis. In this condition, the eyes appear driven downward, the sclera may be seen between the upper eyelid and the iris, and part of the lower pupil may be covered by the lower eyelid. Pathogenesis of this sign is not well understood, but it seems to be related to aqueductal distention with compression of periaqueductal structures secondary to increased intracranial pressure. A CT scan may shiw hydrocephalus . An external ventricular derivation may be needed. Immediately after the procedure, the fontanelle became flat, the setting-sun sign disappeared, and the child can become more alert and started focusing.

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PARINAUD’ Syndrome also known as dorsal midbrain syndrome vertical gaze palsy and sunset sign is an inability to mve eyes up& down.It is caused by lesions of upper brain stem ,quadrigeminal area and named for Hanri Parinaud Chacterised by Upgaze palsy Pupillary light near disociation Convergence retractio nystagmus Loalise pathology in tectal plate , most frequently due to posterior comissure or pineal region mass typically solid tumor rather than pineal cyst

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Setting sun Present in hydrocephalus. Shunting ventriculo peritoneal shunt.

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Sunset sign. Hydrocephalus may may be Obstructiveor SOL. Dysmorphic, Rt eye boll inner deviationand left eye literally deviated. Big philtremwidely placed eyes Absent eye brows. Syndromic presentation. MRI brain. Fundus exam.

Sunset sign /hydrocephalus /vomitings seizures/medical management VP shunt

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Sun setting sign. Hydrocephelous. It has to be treated surgically by v p shunt

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sunset sign hydrocephalus vp shunt

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Setting sun sign Due to vertical gaze palsy Seen in parinauds syndrome

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[06/04, 09:01] Dr Mujeeb: Sunset eye sign. The sunset eye sign (also known as the setting sun phenomenon) is a clinical phenomenon encountered in infants and young children with raised intracranial pressure (seen in up to 40% of children with obstructive hydrocephalus and 13% of children with shunt dysfunction. treatments include eyeglasses, contacts, acrylic corneal implants, LASIK, radial keratotomy (RK) and photorefractive keratotomy (PRK).

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Sunset sign in hydrocephalous Vp shunting

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