case_images: PMC9978917_01
case_images: T1-weighted cranial MRI. a, b The axial images of MRI show an enlarged third and lateral ventricle with normal size of fourth ventricle. No evidence of atypical or secondary parkinsonism. c Coronal T1-weighted imaging does not have a feature of DESH. d CISS imaging demonstrates the stenosis of the midbrain aqueduct (white arrowhead). e Phase-contrast cine MRI shows no cerebrospinal fluid flow in the same area (white arrow). f123I-ioflupane single-photon emission computed tomography (DAT scan ) shows slightly reduced uptake in the bilateral, dorsal parts of the striatum (white asterisk).
case_images: crn-2023-0015-0001-529532_f1.jpg
case_images: PMC9978917_01_crn-2023-0015-0001-529532_f1.jpg
case_images: F1
case_images: Cranial magnetic resonance imaging (MRI) revealed the marked enlargement of the lateral and third ventricles (Fig. 1a, b), whereas neither disproportionately enlarged subarachnoid-space hydrocephalus findings nor the imaging features of atypical/secondary parkinsonism were observed (Fig. 1c). Subsequent constructive interference in steady-state imaging confirmed aqueductal stenosis by abnormal membranous structures (Fig. 1d), which was accompanied by almost complete loss of cerebrospinal fluid (CSF) flow on cine MRI (Fig. 1e). Furthermore, the presence of mild parkinsonism, olfactory dysfunction, and slightly decreased uptake of striatal dopamine transporter imaging (Fig. 1f) suggested comorbid PD.
case_images: a Postoperative MRI confirmed the fenestrated floor of the third ventricle (white arrow). b Phase-contrast cine MRI detects CSF flow in the same area (white arrowhead).
case_images: crn-2023-0015-0001-529532_f2.jpg
case_images: PMC9978917_01_crn-2023-0015-0001-529532_f2.jpg
case_images: F2
case_images: Successful fenestration in the floor of the third ventricle was confirmed by postoperative MRI (Fig. 2a), and CSF flow in the same area was observed by cine MRI (Fig. 2b).