Parkinsonian syndrome in the course of aqueductal stenosis hydrocephalus

Abstract

Report of a case of hydrocephalus secondary to stenosis of the aqueduct with associated parkinsonian syndrome. The suggested etiopathogenesis: damage to the striatal system favored by underlying weakness of the basal ganglia.

Sylvian aqueduct syndrome and global rostral midbrain dysfunction associated with shunt malfunction

“…10,15,27,35,36,44,52 It is induced by the involvement of the periaqueductal gray matter and ventral tegmentum 27 and has also been described as dorsal midbrain syndrome 13,14,55 or pretectal syndrome. 11,28 During shunt malfunction in patients affected by aqueductal stenosis, this syndrome can be associated with more complex features such as parkinsonian syndrome, 3,5,8,21,56 akinetic mutism, 5,12,21,41 memory disturbances, 12,21 staring gaze as a consequence of paralysis of the reflexes of fixation and pursuit, 10 pyramidal signs, 3 and coma. 3,12,21 This clinical entity, well known in the neurosurgical literature, was defined by Barrer, et al, 3 as global rostral midbrain dysfunction on the basis of two clinical observations.…”

How should primary aqueductal stenosis in adults be treated? - A review

“…Rare symptoms in AS are trigeminal neuralgia (32,33), hearing loss and vertigo (34), depression (35) and hypothalamic obesity (36). Parkinsonism in AS patients has been observed in connection with shunt dysfunction (37,38). Amenorrhea, diabetes insipidus, hypogonadism, precocious puberty and other endocrine symptoms were found in 20 (13%) of 150 AS cases studied by Rotilio et al (39).…”

Akinetic Mutism and Parkinsonism after Multiple Shunt Failure: Case Report and Literature Review

“…During shunt malfunction in patients affected by aqueductal stenosis, this syndrome can be associated with more complex features such as parkinsonian syndrome. 4,5,7 and akinetic mutism. 7,17 The cases of complete mutism in humans following a lesion to the PAG are extremely rare in the literature.…”

“…4,5,7 and akinetic mutism. 7,17 The cases of complete mutism in humans following a lesion to the PAG are extremely rare in the literature. 10 Our patient showed an association of Parinaud syndrome, akinetic mutism and parkinsonian syndrome following recurrent hydrocephalus related to multiple failed procedures (third ventriculostomy and ventriculoperitoneal shunt), but she had been diagnosed with a dorsal midbrain lesion, presumably a benign glioma, which certainly played an adjuvant role in the pathophysiology while compressing the periaqueductal grey area and the dopaminergic projections, particularly in the situation of elevated intracranial pressure (ICP).…”