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Endoscopic third ventriculotomy improves parkinsonism following a ventriculo-peritoneal shunt in a patient with non-communicating hydrocephalus secondary to idiopathic aqueduct stenosis.
[hydrocephalus with stenosis of the aqueduct of sylvius]
We
report
a
47
-
year
-old
woman
who
manifested
ocular
motility
disorder
,
bilateral
pyramidal
signs
,
and
severe
parkinsonism
after
a
ventriculo-peritoneal
shunt
for
non
communicating
hydrocephalus
secondary
to
idiopathic
aqueduct
stenosis
.
The
ocular
motility
disorder
consisted
of
severe
vertical
gaze
palsy
and
convergence
retraction
nystagmus
.
Parkinsonism
included
not
only
bradykinesia
but
also
resting
tremor
and
cogwheel
rigidity
.
On
the
other
hand
,
striatal
uptake
did
not
decrease
in
(
18
)
F-
dihydroxyphenylalanine
positron
emission
tomography
,
and
anti-
Parkinsonian
drugs
were
not
effective
.
99
mTc-ethyl
cysteinate
dimer
bicisate
single
-photon
emission
computed
tomography
and
F-
18
fluorodeoxyglucose
positron
emission
tomography
revealed
wide
-ranged
frontal
cerebral
cortical
dysfunction
due
to
midbrain
dysfunction
.
Moreover
,
endoscopic
third
ventriculotomy
markedly
improved
the
clinical
symptoms
as
well
as
the
frontal
cerebral
cortical
flow
.
A
neural
network
formation
known
as
the
'
cortico-
basal
ganglia
loop
,
'
which
intimately
connects
the
frontal
lobe
with
the
basal
ganglia
,
is
possibly
associated
with
the
Parkinsonism
observed
in
our
patient
.