Sylvian aqueduct syndrome and global rostral midbrain dysfunction associated with shunt malfunction

View More View Less
  • 1 Department of Pediatric Neurosurgery and Pediatric Radiology, Hôpital Necker—Enfants Malades, Université René Descartes, Paris, France; and Department of Neurosurgery, Hôpital Lariboisiere, Paris, France
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

Object. This study is a retrospective analysis of clinical data obtained in 28 patients affected by obstructive hydrocephalus who presented with signs of midbrain dysfunction during episodes of shunt malfunction.

Methods. All patients presented with an upward gaze palsy, sometimes associated with other signs of oculomotor dysfunction. In seven cases the ocular signs remained isolated and resolved rapidly after shunt revision. In 21 cases the ocular signs were variably associated with other clinical manifestations such as pyramidal and extrapyramidal deficits, memory disturbances, mutism, or alterations in consciousness. Resolution of these symptoms after shunt revision was usually slow. In four cases a transient paradoxical aggravation was observed at the time of shunt revision. In 11 cases ventriculocisternostomy allowed resolution of the symptoms and withdrawal of the shunt.

Simultaneous supratentorial and infratentorial intracranial pressure recordings performed in seven of the patients showed a pressure gradient between the supratentorial and infratentorial compartments, with a higher supratentorial pressure before shunt revision. Inversion of this pressure gradient was observed after shunt revision and resolution of the gradient was observed in one case after third ventriculostomy. In six recent cases, a focal midbrain hyperintensity was evidenced on T2-weighted magnetic resonance imaging sequences at the time of shunt malfunction. This rapidly resolved after the patient underwent third ventriculostomy.

Conclusions. It is probable that in obstructive hydrocephalus, at the time of shunt malfunction, the development of a transtentorial pressure gradient could initially induce a functional impairment of the upper midbrain, inducing upward gaze palsy. The persistence of the gradient could lead to a global dysfunction of the upper midbrain. Third ventriculostomy contributes to equalization of cerebrospinal fluid pressure across the tentorium by restoring free communication between the infratentorial and supratentorial compartments, resulting in resolution of the patient's clinical symptoms.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1.

    Avman N, , Gökalp HZ, & Arasil E, et al: Symptomatology, evaluation and treatment of aqueductal stenosis. Neurol Res 6:194198, 1984 Avman N, Gökalp HZ, Arasil E, et al: Symptomatology, evaluation and treatment of aqueductal stenosis. Neurol Res 6:194–198, 1984

    • Search Google Scholar
    • Export Citation
  • 2.

    Baloh RW, , Furman JM, & Yee RD: Dorsal midbrain syndrome: clinical and oculographic findings. Neurology 35:5460, 1985 Baloh RW, Furman JM, Yee RD: Dorsal midbrain syndrome: clinical and oculographic findings. Neurology 35:54–60, 1985

    • Search Google Scholar
    • Export Citation
  • 3.

    Barrer SJ, , Schut L, & Bruce DA: Global rostral midbrain dysfunction secondary to shunt malfunction in hydrocephalus. Neurosurgery 7:322325, 1980 Barrer SJ, Schut L, Bruce DA: Global rostral midbrain dysfunction secondary to shunt malfunction in hydrocephalus. Neurosurgery 7:322–325, 1980

    • Search Google Scholar
    • Export Citation
  • 4.

    Beckett RS, , Netsky MG, & Zimmerman HM: Developmental stenosis of the aqueduct of Sylvius. Am J Pathol 26:755787, 1950 Beckett RS, Netsky MG, Zimmerman HM: Developmental stenosis of the aqueduct of Sylvius. Am J Pathol 26:755–787, 1950

    • Search Google Scholar
    • Export Citation
  • 5.

    Berger L, , Gauthier S, & Leblanc R: Akinetic mutism and parkinsonism associated with obstructive hydrocephalus. Can J Neurol Sci 12:255258, 1985 Berger L, Gauthier S, Leblanc R: Akinetic mutism and parkinsonism associated with obstructive hydrocephalus. Can J Neurol Sci 12:255–258, 1985

    • Search Google Scholar
    • Export Citation
  • 6.

    Bogousslavsky J, , Miklossy J, & Regli F, et al: Vertical gaze palsy and selective unilateral infarction of the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF). J Neurol Neurosurg Psychiatry 53:6771, 1990 Bogousslavsky J, Miklossy J, Regli F, et al: Vertical gaze palsy and selective unilateral infarction of the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF). J Neurol Neurosurg Psychiatry 53:67–71, 1990

    • Search Google Scholar
    • Export Citation
  • 7.

    Büttner-Ennever JA, & Büttner U, et al: Vertical gaze paralysis and the rostral interstitial nucleus of the medial longitudinal fasciculus. Brain 105:125149, 1982 Büttner-Ennever JA, Büttner U, et al: Vertical gaze paralysis and the rostral interstitial nucleus of the medial longitudinal fasciculus. Brain 105:125–149, 1982

    • Search Google Scholar
    • Export Citation
  • 8.

    Cantini R, , Ferrito G, & Lutzemberger L, et al: Parkinsonian syndrome in the course of aqueductal stenosis hydrocephalus. Ital J Neurol Sci 9:603606, 1988 Cantini R, Ferrito G, Lutzemberger L, et al: Parkinsonian syndrome in the course of aqueductal stenosis hydrocephalus. Ital J Neurol Sci 9:603–606, 1988

    • Search Google Scholar
    • Export Citation
  • 9.

    Cassinari V, , Pagni CA, & Vitale A: Sindrome di Parinaud in corso di idrocefalo cronico iperteso: sofferenza della regione mesencefalica da dilatazione della porzione posteriore del III ventricolo? Minerva Neurochir 7:8488, 1963 Cassinari V, Pagni CA, Vitale A: Sindrome di Parinaud in corso di idrocefalo cronico iperteso: sofferenza della regione mesencefalica da dilatazione della porzione posteriore del III ventricolo? Minerva Neurochir 7:84–88, 1963

    • Search Google Scholar
    • Export Citation
  • 10.

    Chattha AS, & Delong GR: Sylvian aqueduct syndrome as a sign of acute obstructive hydrocephalus in children. J Neurol Neurosurg Psychiatry 38:288296, 1975 Chattha AS, Delong GR: Sylvian aqueduct syndrome as a sign of acute obstructive hydrocephalus in children. J Neurol Neurosurg Psychiatry 38:288–296, 1975

    • Search Google Scholar
    • Export Citation
  • 11.

    Christoff N: A clinicopathological study of vertical eye movements. Arch Neurol 31:18, 1974 Christoff N: A clinicopathological study of vertical eye movements. Arch Neurol 31:1–8, 1974

    • Search Google Scholar
    • Export Citation
  • 12.

    Cophignon J, , George B, & Visot A, et al: Syndrome de Parinaud et troubles mnésiques au cours des poussées de décompensation de l'hydrocéphalie non tumorale de l'adulte. Neurochirurgie 22:124131, 1976 Cophignon J, George B, Visot A, et al: Syndrome de Parinaud et troubles mnésiques au cours des poussées de décompensation de l'hydrocéphalie non tumorale de l'adulte. Neurochirurgie 22:124–131, 1976

    • Search Google Scholar
    • Export Citation
  • 13.

    Costantino A, , Black SE, & Carr T, et al: Dorsal midbrain syndrome in multiple sclerosis with magnetic resonance imaging correlation. Can J Neurol Sci 13:6265, 1986 Costantino A, Black SE, Carr T, et al: Dorsal midbrain syndrome in multiple sclerosis with magnetic resonance imaging correlation. Can J Neurol Sci 13:62–65, 1986

    • Search Google Scholar
    • Export Citation
  • 14.

    Daroff RB, & Troost BT: Supranuclear disorders of eye movements, in Glaser JS (ed): Neuroophthalmology. Hagerstown: Harper & Row, 1978, p 214 Daroff RB, Troost BT: Supranuclear disorders of eye movements, in Glaser JS (ed): Neuroophthalmology. Hagerstown: Harper & Row, 1978, p 214

    • Search Google Scholar
    • Export Citation
  • 15.

    Elschnig: Nystagmus retractorius, ein cerebrales Herdsymptom. Med Klin 10:811, 1913 Elschnig: Nystagmus retractorius, ein cerebrales Herdsymptom. Med Klin 10:8–11, 1913

    • Search Google Scholar
    • Export Citation
  • 16.

    Fiume D, , Cocco G, & Santucci N: Sindrome di Parinaud da aneurisma della comunicante anteriore. Riv Neurol 51:4348, 1981 Fiume D, Cocco G, Santucci N: Sindrome di Parinaud da aneurisma della comunicante anteriore. Riv Neurol 51:43–48, 1981

    • Search Google Scholar
    • Export Citation
  • 17.

    Fox JL, , McCullough DC, & Green RC: Effect of cerebrospinal fluid shunts on intracranial pressure and on cerebrospinal fluid dynamics. 2. A new technique of pressure measurements: results and concepts. 3. A concept of hydrocephalus. J Neurol Neurosurg Psychiatry 36:302312, 1973 Fox JL, McCullough DC, Green RC: Effect of cerebrospinal fluid shunts on intracranial pressure and on cerebrospinal fluid dynamics. 2. A new technique of pressure measurements: results and concepts. 3. A concept of hydrocephalus. J Neurol Neurosurg Psychiatry 36:302–312, 1973

    • Search Google Scholar
    • Export Citation
  • 18.

    Fredericks EJ, & Van Nuis C: Diverticulum of the rostral cerebral aqueduct with ocular dysfunctions. Arch Neurol 16:3236, 1967 Fredericks EJ, Van Nuis C: Diverticulum of the rostral cerebral aqueduct with ocular dysfunctions. Arch Neurol 16:32–36, 1967

    • Search Google Scholar
    • Export Citation
  • 19.

    Galibert P, , Delcour J, & Rosat P, et al: Tentative d'interprétation de la décompensation de l'hydrocéphalie chronique de l'adulte. Neurochirurgie 22:131138, 1976 Galibert P, Delcour J, Rosat P, et al: Tentative d'interprétation de la décompensation de l'hydrocéphalie chronique de l'adulte. Neurochirurgie 22:131–138, 1976

    • Search Google Scholar
    • Export Citation
  • 20.

    George B, & Benoit O: Activité réticulaire et pression intracranienne. Hypertension intracranienne aigue et chronique. Acta Neurochir 38:195209, 1977 George B, Benoit O: Activité réticulaire et pression intracranienne. Hypertension intracranienne aigue et chronique. Acta Neurochir 38:195–209, 1977

    • Search Google Scholar
    • Export Citation
  • 21.

    George B, , Cophignon J, & Philippon J: Syndrome de Parinaud: signification et valeur pronostique au cours d'une hydrocéphalie. Nouv Presse Med 9:16851688, 1980 George B, Cophignon J, Philippon J: Syndrome de Parinaud: signification et valeur pronostique au cours d'une hydrocéphalie. Nouv Presse Med 9:1685–1688, 1980

    • Search Google Scholar
    • Export Citation
  • 22.

    George B, , Levante A, & Visot A, et al: Tentative d'explication des décompensations d'hydrocéphalie par des modifications de l'activité réticulaire. Neurochirurgie 23:3746, 1977 George B, Levante A, Visot A, et al: Tentative d'explication des décompensations d'hydrocéphalie par des modifications de l'activité réticulaire. Neurochirurgie 23:37–46, 1977

    • Search Google Scholar
    • Export Citation
  • 23.

    Globus JH, & Bergman P: Atresia and stenosis of the aqueduct of Sylvius. J Neuropathol Exp Neurol 5:342363, 1946 Globus JH, Bergman P: Atresia and stenosis of the aqueduct of Sylvius. J Neuropathol Exp Neurol 5:342–363, 1946

    • Search Google Scholar
    • Export Citation
  • 24.

    Guiot G, , Derome P, & Hertzog E, et al: Ventriculo-cisternostomie sous contrôle radioscopique pour hydrocéphalie obstructive. Presse Med 76:19231926, 1968 Guiot G, Derome P, Hertzog E, et al: Ventriculo-cisternostomie sous contrôle radioscopique pour hydrocéphalie obstructive. Presse Med 76:1923–1926, 1968

    • Search Google Scholar
    • Export Citation
  • 25.

    Hamer J, & Martin K: Parinaud-Syndrom bei nicht tumorbedingter Hidrozephaler Hirndrucksteigerung. Neuropaediatrie 7:217223, 1976 Hamer J, Martin K: Parinaud-Syndrom bei nicht tumorbedingter Hidrozephaler Hirndrucksteigerung. Neuropaediatrie 7:217–223, 1976

    • Search Google Scholar
    • Export Citation
  • 26.

    Harrison MJG, , Robert CM, & Uttley D: Benign aqueduct stenosis in adults. J Neurol Neurosurg Psychiatry 37:13221328, 1974 Harrison MJG, Robert CM, Uttley D: Benign aqueduct stenosis in adults. J Neurol Neurosurg Psychiatry 37:1322–1328, 1974

    • Search Google Scholar
    • Export Citation
  • 27.

    Hatcher MA Jr, & Klintworth GK: The Sylvian aqueduct syndrome. A clinicopathological study. Arch Neurol 15:215222, 1966 Hatcher MA Jr, Klintworth GK: The Sylvian aqueduct syndrome. A clinicopathological study. Arch Neurol 15:215–222, 1966

    • Search Google Scholar
    • Export Citation
  • 28.

    Hironishi M, , Koshimura I, & Nishi K, et al: [Pretectal syndrome caused by a plaque of multiple sclerosis.] Rinsho Shinkeigaku 34:236240, 1994 (Jpn) Hironishi M, Koshimura I, Nishi K, et al: [Pretectal syndrome caused by a plaque of multiple sclerosis.] Rinsho Shinkeigaku 34:236–240, 1994 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 29.

    Huang YP, , Wolf BS, & Antin SP, et al: Angiographic features of aqueductal stenosis. AJR 104:90108, 1968 Huang YP, Wolf BS, Antin SP, et al: Angiographic features of aqueductal stenosis. AJR 104:90–108, 1968

    • Search Google Scholar
    • Export Citation
  • 30.

    Jakubowski J, & Jefferson A: Axial enlargement of the 3rd ventricle, and displacement of the brain-stem in benign aqueduct stenosis. J Neurol Neurosurg Psychiatry 35:114123, 1972 Jakubowski J, Jefferson A: Axial enlargement of the 3rd ventricle, and displacement of the brain-stem in benign aqueduct stenosis. J Neurol Neurosurg Psychiatry 35:114–123, 1972

    • Search Google Scholar
    • Export Citation
  • 31.

    Jellinger G: Anatomopathology of nontumoral aqueductal stenosis. J Neurosurg Sci 30:116, 1986 Jellinger G: Anatomopathology of nontumoral aqueductal stenosis. J Neurosurg Sci 30:1–16, 1986

    • Search Google Scholar
    • Export Citation
  • 32.

    Johnson RT, & Yates PO: Clinico-pathological aspects of pressure changes at the tentorium. Acta Radiol 46:242249, 1956 Johnson RT, Yates PO: Clinico-pathological aspects of pressure changes at the tentorium. Acta Radiol 46:242–249, 1956

    • Search Google Scholar
    • Export Citation
  • 33.

    Kapila A, , Klingele TG, & Slamovits TL, et al: Quadrigeminal plate compression caused by a pulsion diverticulum. J Clin Neuroophthalmol 1:135140, 1981 Kapila A, Klingele TG, Slamovits TL, et al: Quadrigeminal plate compression caused by a pulsion diverticulum. J Clin Neuroophthalmol 1:135–140, 1981

    • Search Google Scholar
    • Export Citation
  • 34.

    Kaufmann GE, & Clark K: Continuous simultaneous monitoring of intraventricular and cervical subarachnoid cerebrospinal fluid pressure to indicate development of cerebral or tonsillar herniation. J Neurosurg 33:145150, 1970 Kaufmann GE, Clark K: Continuous simultaneous monitoring of intraventricular and cervical subarachnoid cerebrospinal fluid pressure to indicate development of cerebral or tonsillar herniation. J Neurosurg 33:145–150, 1970

    • Search Google Scholar
    • Export Citation
  • 35.

    Kestenbaum A: Clinical Methods of Neuro-Ophthalmologic Examination. New York: Grune & Stratton, 1946, p 255 Kestenbaum A: Clinical Methods of Neuro-Ophthalmologic Examination. New York: Grune & Stratton, 1946, p 255

    • Search Google Scholar
    • Export Citation
  • 36.

    Koerber H: Über drei Fälle von Retraktionsbewegung des Bulbus (Nystagmus retractorius). Ophtalmol Klin 10:6569, 1903 Koerber H: Über drei Fälle von Retraktionsbewegung des Bulbus (Nystagmus retractorius). Ophtalmol Klin 10:65–69, 1903

    • Search Google Scholar
    • Export Citation
  • 37.

    Lapras C, , Bret P, & Tommasi M, et al: Les sténoses de l'aqueduc de Sylvius. Neurochirurgie 26 (Suppl 1):1152, 1980 Lapras C, Bret P, Tommasi M, et al: Les sténoses de l'aqueduc de Sylvius. Neurochirurgie 26 (Suppl 1):1–152, 1980

    • Search Google Scholar
    • Export Citation
  • 38.

    Lavender JP, & Du Boulay GH: Aqueduct stenosis and cystic expansion of the suprapineal recess. Clin Radiol 16:330333, 1965 Lavender JP, Du Boulay GH: Aqueduct stenosis and cystic expansion of the suprapineal recess. Clin Radiol 16:330–333, 1965

    • Search Google Scholar
    • Export Citation
  • 39.

    Lerner MA, , Kosary IZ, & Cohen BE: Parinaud's syndrome in aqueduct stenosis: its mechanism and ventriculographic features. Br J Radiol 42:310312, 1969 Lerner MA, Kosary IZ, Cohen BE: Parinaud's syndrome in aqueduct stenosis: its mechanism and ventriculographic features. Br J Radiol 42:310–312, 1969

    • Search Google Scholar
    • Export Citation
  • 40.

    Lim ST, , Potts DG, & Deonarine V, et al: Ventricular compliance in dogs with and without aqueductal obstruction. J Neurosurg 39:463473, 1973 Lim ST, Potts DG, Deonarine V, et al: Ventricular compliance in dogs with and without aqueductal obstruction. J Neurosurg 39:463–473, 1973

    • Search Google Scholar
    • Export Citation
  • 41.

    Messert B, , Henke TK, & Langheim W: Syndrome of akinetic mutism associated with obstructive hydrocephalus. Neurology 16:635649, 1966 Messert B, Henke TK, Langheim W: Syndrome of akinetic mutism associated with obstructive hydrocephalus. Neurology 16:635–649, 1966

    • Search Google Scholar
    • Export Citation
  • 42.

    Mott M, & Cummins B: Hydrocephalus related to pulsion diverticulum of lateral ventricle. Arch Dis Child 49:407410, 1974 Mott M, Cummins B: Hydrocephalus related to pulsion diverticulum of lateral ventricle. Arch Dis Child 49:407–410, 1974

    • Search Google Scholar
    • Export Citation
  • 43.

    Naidich TP, , McLone DG, & Hahn YS, et al: Atrial diverticula in severe hydrocephalus. AJNR 3:257266, 1982 Naidich TP, McLone DG, Hahn YS, et al: Atrial diverticula in severe hydrocephalus. AJNR 3:257–266, 1982

    • Search Google Scholar
    • Export Citation
  • 44.

    Nashold BS Jr, & Gills JP Jr: Ocular signs from brain stimulation and lesions. Arch Ophthalmol 77:609618, 1967 Nashold BS Jr, Gills JP Jr: Ocular signs from brain stimulation and lesions. Arch Ophthalmol 77:609–618, 1967

    • Search Google Scholar
    • Export Citation
  • 45.

    Nittner K, & Petrovici IN: Contributions to the pathogenesis of Parinaud's syndrome. Vertical gaze paralysis following bilateral stereotaxic lesion in the interstitial nucleus region. Acta Neurochir Suppl 21:5763, 1974 Nittner K, Petrovici IN: Contributions to the pathogenesis of Parinaud's syndrome. Vertical gaze paralysis following bilateral stereotaxic lesion in the interstitial nucleus region. Acta Neurochir Suppl 21:57–63, 1974

    • Search Google Scholar
    • Export Citation
  • 46.

    Parinaud H: Paralysie des mouvements associés des yeux. Arch Neurol 5:145172, 1883 Parinaud H: Paralysie des mouvements associés des yeux. Arch Neurol 5:145–172, 1883

    • Search Google Scholar
    • Export Citation
  • 47.

    Pierre-Kahn A, , Renier D, & Bombois B, et al: Place de la ventriculo-cisternostomie dans le traitement des hydrocéphalies non communicantes. Neurochirurgie 21:557569, 1975 Pierre-Kahn A, Renier D, Bombois B, et al: Place de la ventriculo-cisternostomie dans le traitement des hydrocéphalies non communicantes. Neurochirurgie 21:557–569, 1975

    • Search Google Scholar
    • Export Citation
  • 48.

    Pierrot-Deseilligny C, & Chain F, et al: Parinaud's syndrome. Electro-oculographic and anatomical analyses of six vascular cases with deductions about vertical gaze organization in the premotor structures. Brain 105:667696, 1982 Pierrot-Deseilligny C, Chain F, et al: Parinaud's syndrome. Electro-oculographic and anatomical analyses of six vascular cases with deductions about vertical gaze organization in the premotor structures. Brain 105:667–696, 1982

    • Search Google Scholar
    • Export Citation
  • 49.

    Pires Ferreira N, & Brandalise A Jr: Sèndrome de Parinaud indicando hidrocéfalo descompensado em pacientes com derivaçao liquórica. Arq Neuropsiquiatr 36:216220, 1978 Pires Ferreira N, Brandalise A Jr: Sèndrome de Parinaud indicando hidrocéfalo descompensado em pacientes com derivaçao liquórica. Arq Neuropsiquiatr 36:216–220, 1978

    • Search Google Scholar
    • Export Citation
  • 50.

    Reddy K, , Fewer HD, & West M, et al: Slit ventricle syndrome with aqueduct stenosis: third ventriculostomy as definitive treatment. Neurosurgery 23:756759, 1988 Reddy K, Fewer HD, West M, et al: Slit ventricle syndrome with aqueduct stenosis: third ventriculostomy as definitive treatment. Neurosurgery 23:756–759, 1988

    • Search Google Scholar
    • Export Citation
  • 51.

    Rekate HL: Brain turgor (Kb): intrinsic property of the brain to resist distortion. Pediatr Neurosurg 18:257262, 1992 Rekate HL: Brain turgor (Kb): intrinsic property of the brain to resist distortion. Pediatr Neurosurg 18:257–262, 1992

    • Search Google Scholar
    • Export Citation
  • 52.

    Salus R: On acquired retraction movements of the eyes. Arch Ophthalmol 42:3444, 1913 Salus R: On acquired retraction movements of the eyes. Arch Ophthalmol 42:34–44, 1913

    • Search Google Scholar
    • Export Citation
  • 53.

    Serdaru M, , Gray F, & Lyon-Caen, et al: Syndrome de Parinaud et déviation tonique verticale du regard. Rev Neurol 138:601617, 1982 Serdaru M, Gray F, Lyon-Caen, et al: Syndrome de Parinaud et déviation tonique verticale du regard. Rev Neurol 138:601–617, 1982

    • Search Google Scholar
    • Export Citation
  • 54.

    Shallat RF, , Pawl RP, & Jerva MJ: Significance of upward gaze palsy (Parinaud's syndrome) in hydrocephalus due to shunt malfunction. J Neurosurg 38:717721, 1973 Shallat RF, Pawl RP, Jerva MJ: Significance of upward gaze palsy (Parinaud's syndrome) in hydrocephalus due to shunt malfunction. J Neurosurg 38:717–721, 1973

    • Search Google Scholar
    • Export Citation
  • 55.

    Slyman JF, & Kline LB: Dorsal midbrain syndrome in multiple sclerosis. Neurology 31:196198, 1981 Slyman JF, Kline LB: Dorsal midbrain syndrome in multiple sclerosis. Neurology 31:196–198, 1981

    • Search Google Scholar
    • Export Citation
  • 56.

    Spagna VA, , Maeder MC, & Johnson JC, et al: Normal pressure hydrocephalus, parkinsonism, and primary empty sella—coincidence or cause-effect? Neurology 28:11911193, 1978 Spagna VA, Maeder MC, Johnson JC, et al: Normal pressure hydrocephalus, parkinsonism, and primary empty sella—coincidence or cause-effect? Neurology 28:1191–1193, 1978

    • Search Google Scholar
    • Export Citation
  • 57.

    Striano S, , Luciano R, & Meo R, et al: Disordini sopranucleari dei movimenti oculari. Fisiopatologia, semeiologia e valore topodiagnostico. Acta Neurol 12:151171, 1990 Striano S, Luciano R, Meo R, et al: Disordini sopranucleari dei movimenti oculari. Fisiopatologia, semeiologia e valore topodiagnostico. Acta Neurol 12:151–171, 1990

    • Search Google Scholar
    • Export Citation
  • 58.

    Swash M: Periaqueductal dysfunction (the Sylvian aqueduct syndrome): a sign of hydrocephalus? J Neurol Neurosurg Psychiatry 37:2126, 1974 Swash M: Periaqueductal dysfunction (the Sylvian aqueduct syndrome): a sign of hydrocephalus? J Neurol Neurosurg Psychiatry 37:21–26, 1974

    • Search Google Scholar
    • Export Citation
  • 59.

    Visot A, , Cophignon J, & George B, et al: Sténoses de l'aqueduc chez l'adulte. Neurochirurgie 22:118124, 1976 Visot A, Cophignon J, George B, et al: Sténoses de l'aqueduc chez l'adulte. Neurochirurgie 22:118–124, 1976

    • Search Google Scholar
    • Export Citation
  • 60.

    Wakai S, , Narita J, & Hashimoto K, et al: Diverticulum of the lateral ventricle causing cerebellar ataxia. Case report. J Neurosurg 59:895898, 1983 Wakai S, Narita J, Hashimoto K, et al: Diverticulum of the lateral ventricle causing cerebellar ataxia. Case report. J Neurosurg 59:895–898, 1983

    • Search Google Scholar
    • Export Citation
  • 61.

    Walsh FB, & Hoyt WF: Clinical Neuro-Ophthalmology, ed 3. Baltimore: Williams & Wilkins, 1969, pp 228232 Walsh FB, Hoyt WF: Clinical Neuro-Ophthalmology, ed 3. Baltimore: Williams & Wilkins, 1969, pp 228–232

    • Search Google Scholar
    • Export Citation
  • 62.

    Williams B: Cerebrospinal fluid pressure-gradients in spina bifida cystica, with special reference to the Arnold-Chiari malformation and aqueductal stenosis. Dev Med Child Neurol Suppl 35:138150, 1975 Williams B: Cerebrospinal fluid pressure-gradients in spina bifida cystica, with special reference to the Arnold-Chiari malformation and aqueductal stenosis. Dev Med Child Neurol Suppl 35:138–150, 1975

    • Search Google Scholar
    • Export Citation
  • 63.

    Williams B: Is aqueduct stenosis a result of hydrocephalus? Brain 96:399412, 1973 Williams B: Is aqueduct stenosis a result of hydrocephalus? Brain 96:399–412, 1973

    • Search Google Scholar
    • Export Citation
  • 64.

    Wolfla CE, , Luerssen TG, & Bowman RM, et al: Brain tissue pressure gradients created by expanding frontal epidural mass lesion. J Neurosurg 84:642647, 1996 Wolfla CE, Luerssen TG, Bowman RM, et al: Brain tissue pressure gradients created by expanding frontal epidural mass lesion. J Neurosurg 84:642–647, 1996

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 667 144 17
Full Text Views 245 20 1
PDF Downloads 204 25 1
EPUB Downloads 0 0 0