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Festination as the leading symptom of late onset idiopathic aqueductal stenosis
  1. O Leheta1,
  2. J Boschert1,
  3. J K Krauss1,
  4. I R Whittle2
  1. 1Department of Neurosurgery, University Hospital, Klinikum Mannheim, Mannheim, Germany
  2. 2Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
  1. Correspondence to:
 Prof Dr J K Krauss, Department of Neurosurgery, University Hospital, Klinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany;
 joachim.krauss{at}nch.ma.uni-heidelberg.de

https://doi.org/10.1136/jnnp.73.5.599

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    Late onset idiopathic aqueductal stenosis (IAS) may become manifest clinically either by headaches or by hydrocephalic symptoms such as gait disturbance, urinary urge, and cognitive impairment.1 Rarely, patients with IAS may also present with parkinsonism following repeated episodes of shunt failure.2,3 Although the gait disorder of IAS has not been fully characterised, it shares similar features with that of normal pressure hydrocephalus of the elderly. Here, we report on two patients who presented with festination as the leading symptom of IAS.

    Case histories

    Case 1

    A 59 year old man had a seven year history of gait disturbance. During the months before admission, he became more unsteady and he was not able to walk without assistance because of pronounced hastening of his steps. He fell frequently. For several months, no diagnosis was made and his gait disorder was considered possibly to be psychogenic. Only after imaging studies showed pronounced triventricular hydrocephalus was he referred for further evaluation and treatment. On admission, he also reported occasional nocturnal urinary urge and incontinence. The most remarkable finding of his physical examination was his gait disorder. He was able to walk without falling only when holding on to a handrail or to the wall. When he walked freely, his stride length became successively shorter and step height decreased, while his walking speed increased. He was unable to …

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    Footnotes

    • Competing interests: none declared

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