From the Guidelines
Aqueductal stenosis typically manifests with symptoms of obstructive hydrocephalus, including increased intracranial pressure, headaches, nausea, vomiting, and visual disturbances.
Clinical Manifestations
- Intractable vomiting and hiccoughs can occur when lesions are present in the area postrema, a region adjacent to the fourth ventricle and the cerebral aqueduct 1.
- Lesions around the cerebral aqueduct (periaqueductal) may lead to aqueductal stenosis and subsequent obstructive hydrocephalus 1.
- Ataxia and cerebellar signs may also be present due to the involvement of the cerebellar peduncles and white matter.
Diagnostic Considerations
- MRI abnormalities, such as lesions in the dorsal brainstem and around the cerebral aqueduct, can aid in the diagnosis of aqueductal stenosis and underlying conditions like neuromyelitis optica spectrum disorders 1.
- The presence of periaqueductal lesions and area postrema syndrome can be indicative of neuromyelitis optica spectrum disorders, which can cause aqueductal stenosis 1.
From the Research
Clinical Manifestations of Aqueductal Stenosis
The clinical manifestations of aqueductal stenosis can vary, but some common symptoms and findings include:
- Increased intracranial pressure secondary to obstruction of the aqueduct of Sylvius 2
- Acute-onset headache and vomiting 3
- Dementia (although infrequent) 4
- Cranial enlargement and signs of chronic increased intracranial pressure on skull x-ray films 4
- Characteristic alterations of the sella, including elongation of the anterior wall and flattening, erosion, and anterior displacement of the dorsum 4
- Hydrocephalus, which may have been present since early life 4
Modes of Clinical Presentation
There are five modes of clinical presentation of aqueductal stenosis in adults, although the exact modes are not specified in the provided studies 4. However, it is noted that some cases may present with symptoms of increased intracranial pressure, while others may be asymptomatic until later in life 5, 3.
Complications and Treatment
Complications of aqueductal stenosis can include subdural hematoma as a result of overshunting 3. Treatment typically involves shunt insertion, which can lead to substantial improvement in symptoms 4. In some cases, valve revision to a programmable valve may be necessary 3.