Transient akinetic mutism induced by malfunction of a ventriculo-peritoneal shunt for obstructive hydrocephalus associated with aqueductal stenosis: Case report

Abstract

We report a rare case of akinetic mutism resulting from multiple revisions of a ventriculo-peritoneal shunt (V-P shunt) for obstructive hydrocephalus. An 18-year-old man presented at our department complaining of a headache and vomiting. He had been given a V-P shunt for hydrocephalus associated with aqueductal stenosis when he was 15 years old. A CT-scan revealed a ventricular dilatation and shunt malfunction was suspected. The shunt system was revised 4 times during a following 2-month period. The size of the ventricles decreased. However, he gradually developed a clinical syndrome of akinetic mutism with parkinsonism. He was given levodopa (300 mg/day) and amantadine hydrochloride (150 mg/ day). Two months later, his behavioral syndrome rapidly improved. Over the following three months, the medication was discontinued. He has been well during the recent 7-year follow-up period. We discuss the etiology, treatment, and prevention of this rare complication.