Aqueductal Stenosis Presenting as Isolated Tremor: Case Report and Review of the Literature

Abstract

Essential tremor is rare in children, particularly in the absence of a significant family history. We report the case of a child with compensated hydrocephalus secondary to aqueductal stenosis whose sole presenting symptom was tremor. An otherwise healthy 6-year-old male developed a fine hand tremor, which over the course of 4 years both increased in intensity and spread to involve the lower limbs and head. After an MRI had confirmed hydrocephalus due to aqueductal stenosis, the patient underwent an endoscopic third ventriculostomy. His tremor improved markedly, but did not completely resolve. Occult hydrocephalus should be considered in the differential diagnosis of new-onset tremor. Progression of the tremor should halt with treatment of the hydrocephalus, and clinical improvement may be seen.

Clinical analysis of aqueductal stenosis in patients with hydrocephalus in a Kenyan setting

“…These results are synchronous with previous studies [11]. Tremors have been reported in previous studies as a presenting complaint but this was not seen in this study [12]. Procedures available in the treatment of hydrocephalus include ventriculoperitoneal shunt and more recently Endoscopic Third ventirulostomy.…”

A case of aqueductal obstruction by web with no sign except a headache

“…Previously there were some reports about aqueductal stenosis patients without severe symptoms who were diagnosed as compensated aqueductal obstruction by web [12] , [13] , [14] . Most patients with this disorder who do not have severe symptoms are referred before the age of 30.…”

Hidden aqueductal stenosis associated to bilateral idiopathic foramina of Monro stenosis mimicking a Chiari I malformation? Case report

“…The most-used radiological diagnostic criterion on MRI for CM I is the downward herniation of cerebellar tonsils (at least 5 mm) [12], obliteration of the retrocerebellar cerebrospinal fluid spaces and a varying degree of cranial base dysplasia (such as shortening of the length of the clivus and/or length of the supraocciput line from opisthion to internal occipital protuberance, increased angle between tentorium and the supraocciput line) [12]. Furthermore, volumetric calculations of posterior fossa and cerebrospinal fluid volume are also available as a diagnostic tool [5,11,17], and usually reveal a volume reduction [4].…”

“…Natural history, diagnosis and treatment of CM I remain controversial and debatable [13][14][15][16][17][18][19][20].…”