Cases of extrapyramidal syndrome associated with obstructive hydrocephalus due to idiopathic aqueductal stenosis
| Case | Age at onset of parkinsonism | Time to onset of parkinsonism after hydrocephalus first diagnosed | Previous shunts before onset of parkinsonism (n) | Parinaud’s syndrome | Hydrocephalus present at onset of parkinsonism? | Response to shunting | Medication prescribed | Drug withdrawal possible |
|---|---|---|---|---|---|---|---|---|
| Case 1 | 57 | 2 y | 3 | Yes | No. But clinical assessment suggested shunt blockage | No immediate improvement | Bromocriptine 3mg bd Sinemet 250 qds | No |
| Case 2 | 22 | 14 months | 2 | Yes | No | Not shunted | Madopar 125 tds increased to 250 tds | Successfully after 2 y |
| Case 31 | 17 | 1 y | Many | Yes | Yes : mild | No immediate improvement | Sinemet 125 tds | Unknown |
| Case 42 | 21 | 9 months | 3 | Yes | Yes | Initially slow improvement | Benztropine 2mg tds Prolopa 100/25 bd | Unknown |
| Case 53 | 14 | At presentation | Nil | Yes | Yes | Initially responded to shunting alone | Sinemet 125 tds | Successful 6 months after last shunt revision |
| Case 64 | 7 | 1 y | 4 | No | Yes | Yes in combination with levodopa | Increasing dosage up to Sinemet 110 qds | Successful after a few months |
| Case 78 | 16 | 1 y | 2 | Yes | No. But nuclear shunt scan showed blockage | Slow improvement | Sinemet 25/100 ½ tab tds | No |
| Case 88 | 26 | 17 y | 1 | Yes | No. Functional status of shunt unknown | None | Sinemet and intravenous lisuride - no response | — |
| Case 99 | 28 | 24 y | 1 | No | Yes | Parkinsonism promptly disappeared | No antiparkinsonian drugs given | — |
bd=twice daily; tds=three times daily; qds=four times daily.