2025 American Academy of Neurology Abstract Website

Objective:

Background:

The Aqueduct of Sylvius connects the third and the fourth ventricle of the brain, and stenosis of this aqueduct may remain clinically asymptomatic for an extended period, sometimes spanning years. This lack of symptoms could be attributed to compensatory mechanisms in cerebrospinal fluid (CSF) flow dynamics, maintaining equilibrium. However, as CSF production increases over time, symptoms may manifest during later stages of life. An aqueductal web is a congenital anomaly composed of ependymal cells and fibrillary neuroglia, that can lead to aqueductal stenosis.

Design/Methods:

Results:

In this report, we describe a 75-year-old male with a 4-month onset of a shuffling gait. Additionally, he has had multiple near falls with freezing of gait and start hesitation. Magnetic resonance imaging of the brain revealed severe narrowing of the aqueduct at the level of the inferior colliculus, alongside enlargement of the lateral ventricles and the third ventricle. Notably, a small web-like projection was observed at the site of greatest narrowing, indicative of an aqueductal web. Further analysis of cerebrospinal fluid flow dynamics confirmed a high degree of aqueductal stenosis attributed to the aqueductal web previously identified.

Subsequently, the patient was referred to Neurosurgery and underwent a successful endoscopic third ventriculostomy. Two days post-surgery, the patient demonstrated improved stability in walking with minimal shuffling.

Conclusions:

This case underscores the significance of identifying the aqueductal web as a potential cause of obstructive hydrocephalus, emphasizing the importance of timely intervention, which can yield favorable outcomes.