ABSTRACT
The sylvian aqueduct syndrome is a global rostral midbrain dysfunction induced by a transtentorial pressure gradient through the aquaeductus. Several months after ventriculoperitoneal shunt, a patient with hydrocephalus began experiencing a constellation of midbrain dysfunction symptoms, including bradykinesia, medial longitudinal fasciculus syndrome, third nerve palsy, and mutism. These were indicative of cerebral aqueduct syndrome. In addition, the patient showed posture-dependent underdrainage or overdrainage. All symptoms were resolved after distal catheter elongation and floating cranioplasty. We present a case of reversible parkinsonism, which developed in a patient with shunted hydrocephalus and aqueductal stenosis, and discuss the diagnosis and treatment of the sylvian aqueduct syndrome. We also review the literature to address problems of drainage and potential treatment modalities.
Subject(s)
Humans , Catheters , Cerebral Aqueduct , Diagnosis , Drainage , Hydrocephalus , Hypokinesia , Mesencephalon , Mutism , Oculomotor Nerve Diseases , Parkinsonian Disorders , Ventriculoperitoneal ShuntABSTRACT
The most frequent cause of continuous ambulatory peritoneal dialysis (CAPD) drainage failure is catheter migration. We experienced a rare case of CAPD drainage failure due to fracture of Tenckhoff catheter. A 56-year-old man presented for evaluation of CAPD drainage failure. KUB showed broken radio opaque line of the Tenckhoff catheter proximal to the internal cuff. It was thought that CAPD drainage failure was due to catheter fracture. CAPD drainage failure had been treated successfully with surgical catheter reinsertion. Our case demonstrated that catheter fracture should be considered in the differential of CAPD drainage failure.