title: Sylvian aqueduct syndrome with slit ventricles in shunted hydrocephalus due to adult aqueduct stenosis.
abstract: The authors report on 3 patients who developed sylvian aqueduct syndrome (SAS) in the context of shunt dysfunction and slit ventricles. All 3 patients had received shunts for adult onset hydrocephalus due to aqueduct stenosis and were stable for years before presenting with loss of upward gaze, convergence-retraction nystagmus, and slit ventricles, all due to shunt overdrainage. All 3 improved after either shunt revision or a third ventriculostomy procedure. Although it is well known that SAS can be caused by shunt blockage producing a transtentorial pressure gradient, these cases emphasize that an identical clinical pattern can occur with a reverse transtentorial pressure gradient and slit ventricles due to shunt overdrainage. The authors propose a simple management plan for patients with shunted hydrocephalus who develop SAS.
authors.affiliation: Department of Neurosurgery, Royal North Shore Hospital, Sydney, Australia.
authors.forename: Helen
authors.initials: H
authors.lastname: Maroulis
authors.forename: G Michael
authors.initials: GM
authors.lastname: Halmagyi
authors.forename: Robert
authors.initials: R
authors.lastname: Heard
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Cook
mesh_terms: D002535:Cerebral Aqueduct / Q000473:pathology / Q000503:physiopathology*; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology; D002557:Cerebrospinal Fluid Shunts; D003251:Constriction, Pathologic / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D006849:Hydrocephalus / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy; D015835:Ocular Motility Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D020542:Third Ventricle / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D014696:Ventriculostomy; D055815:Young Adult