Parkinsonism associated with obstructive hydrocephalus due toidiopathic aqueductal stenosis

Two cases of parkinsonism after recurrent obstructivehydrocephalus due to idiopathic aqueductal stenosis are reported.In both patients an extrapyramidal syndrome was noted in the absence ofcontemporaneous evidence of hydrocephalus or shunt failure. One of thepatients underwent a shunt operation, but showed no clinicalimprovement. However, both patients improved after the administrationof dopaminergic therapy. The seven previously reported cases of thissyndrome were reviewed and it is concluded that the prognosis of theparkinsonism is good, usually with total, or near total, resolution. Itis recommended that if a patient with idiopathic aqueduct stenosisdevelops hydrocephalus or evidence of shunt malfunction in associationwith acute parkinsonism their shunt should be replaced. If there is noevidence of hydrocephalus or shunt malfunction they should initially betreated with domaminergic medication.