Parkinsonism Improved With Levodopa After Endoscopic Third Ventriculostomy in Shunted Hydrocephalus Due to Aqueductal Stenosis

Abstract

The details of this patient suggest that a transtentorial pressure gradient may have impaired more distal basal ganglia connections over a global rostral midbrain including the nigrostriatal pathway, and that aggressive levodopa therapy after endoscopic third ventriculostomy can be effective for refractory parkinsonism.

Transtentorial Fluctuations and Atypical Parkinsonism After Ventriculo-Peritoneal Shunting

“…Dorsal midbrain compression by the pineal tumor caused aqueductal stenosis in this patient and could have contributed to the midbrain syndrome as well. Similar to previously reported cases, 3,[5][6][7] Parkinsonism and oculomotor abnormalities stabilized but persisted after transtentorial fluctuations resolved. This persistence might reflect irreversible damage to dorsal midbrain structures and their connections.…”

“…The exact pathophysiology is unknown, but it likely results from mechanical damage due to dorsal midbrain structures and their connections. [1][2][3][4][5][6][7][8] Here, we describe two patients who developed progressively worsening transtentorial pressure fluctuations, Parkinsonism, and oculomotor abnormalities after VPS.…”

Reversible Reduction of Dopamine Transporter Uptake in a Case of Hydrocephalus

“…123 I‐FP‐CIT SPECT is useful for the diagnosis of neurological disorders with presynaptic dopaminergic deficits. Parkinsonian syndromes associated with communicating and non‐communicating hydrocephalus has been reported, 3 and improved parkinsonism by the combination of levodopa and ETV was reported in a patient with hydrocephalus due to aqueduct stenosis 4 . However, hydrocephalus is not commonly known to be accompanied by 123 I‐FP‐CIT SPECT abnormality.…”

Parkinsonism secondary to ventriculoperitoneal shunt in a patient with hydrocephalus

“…Parkinsonism secondary to the treatment of obstructive hydrocephalus due to cerebral aqueduct stenosis, with ventricular peritoneal (VP) shunt implantation, is a rare complication,[ 1 , 6 , 8 , 9 , 11 , 13 ] still little described and widespread in literature. Parkinsonian syndrome has a prevalence of motor component and can be manifested both after the first surgical approach and after several shunts.…”

“…Parkinsonian syndrome has a prevalence of motor component and can be manifested both after the first surgical approach and after several shunts. [ 8 ] The initial response to dopaminergic drugs is varied, with a slow initial response in most cases reported. [ 1 , 6 , 8 , 9 , 11 , 13 ] Early diagnosis and introduction of clinical and pharmacological treatment are crucial for the patient’s recovery, so it is essential that neurosurgeons pay attention to this rare, but devastating, postoperative complication.…”