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Table 2 Summary of clinical features in patients with Parkinsonism following VP shunt due to hydrocephalus

From: Parkinsonism after ventriculoperitoneal shunt for hydrocephalus

Case n°

Author(s)/year

Age (yrs)/sex

Hydrocephalus (HD)

Operation

Time of onset

Treatment

Prognosis/Time

1

Berger et al., 1985 [8]

21/F

obstructive HD due to AS

multiple shunt

revisions

2 weeks after the first revision

another shunt revision, Cogentin 2 mg TID, Prolopa 100 mg BID

improved following this revision; motor examination was normal on medications/6 months

2

Curran et al., 1994 [9]

16/B

obstructive HD due to AS

multiple shunt

revisions

after the last revision

levodopa/carbidopa

parkinsonism improved

3

21/M

obstructive hydrocephalus secondary to a pineal mass

VP shunt

1 year after VP shunt

levodopa

parkinsonism improved/1 year

4

7/B

obstructive HD due to AS

multiple shunt

revisions

after the last revision

levodopa

parkinsonism improved

5

72/M

normal pressure hydrocephalus

VP shunt

4 years after VP shunt

levodopa

parkinsonism improved

6

Keane et al., 1995 [11]

32/F

obstructive hydrocephalus caused by cysticercosis

multiple shunt

revisions

unknown

placement of a shunt with a low-pressure valve

extrapyramidal signs became less prominent

7

Shahar et al., 1998 [16]

17/B

obstructive HD due to AS

multiple shunt

revisions

2 weeks after the last revision

levodopa/carbidopa 100/25 mg TID

remarkable improvement/1 week

8

Asamoto et al., 1998 [7]

18/F

obstructive HD due to AS

VP shunt

developed acute parkinsonism after the shunt revision

levodopa

parkinsonism improved

9

Zeidler et al., 1998 [24]

57/M

obstructive HD due to AS

VP shunt, subsequent shunt replacement failure, Torkildsen operation

16 months after the last operation

bromocriptine 3 mg BID, Sinemet Plus 2 tablets QID

extrapyramidal signs becoming less prominent

10

21/F

obstructive HD due to AS

multiple shunt

revisions

3 months after the last revision

Madopar 125 mg to 250 mg TID

improvement in rigidity/2 days; spontaneous speech and increased mobility/2 weeks

11

Ochiai et al., 2000 [14]

59/M

obstructive HD

multiple shunt

revisions

3 months after the last revision

bromocriptine/amantadine, L-dopa

bromocriptine/amantadine had no effect; the parkinsonism dramatically improved with administration of L-dopa

12

32/M

obstructive HD

multiple shunt

revisions

3 months after the last revision

bromocriptine/amantadine, L-dopa

bromocriptine/amantadine had no effect; the parkinsonism dramatically improved with administration of L-dopa

13

Sun et al., 2001 [28]

19/M

obstructive HD

VP shunt

4 months after VP shunt

amantadine/Artane

treatment was ineffective; patient died/1 year

14

14/B

obstructive HD

VP shunt

2 months after VP shunt

amantadine/Artane

parkinsonian features improved/unknown

15

21/M

communicating hydrocephalus

VP shunt

3 months after VP shunt

pressure shunt pump

parkinsonian features improved, but patient died of leukaemia/unknown

16

18/M

obstructive HD due to AS

VP shunt

4 months after VP shunt

niacin, amantadine/Artane

parkinsonian features improved/3 days

17

27/F

obstructive HD

VP shunt

2 years after VP shunt

amantadine/Artane, shunt revisions

parkinsonism presented upon use of medication/unknown

18

Tokunaga et al., 2003 [22]

26/M

obstructive hydrocephalus after possible encephalitis

VP shunt

8 months after VP shunt

endoscopic third ventriculostomy

patient became capable of walking/2 months

19

Racette et al., 2004 [17]

44/M

obstructive HD due to AS

VP shunt and shunt

revisions

10 days after revision

levodopa/carbidopa 1500/375 mg QD

improved verbal response time, bradykinesia, and rigidity/unknown

20

Yomo et al., 2006 [23]

64/M

obstructive HD due to AS

VP shunt multiple shunt

revisions

4 months after the VP shunt

levodopa/carbidopa 300/30 mg QD to 600/60 mg QD

parkinsonism presented after several months because of slit ventricle syndrome

21

Kim et al., 2006 [12]

46/M

obstructive HD due to AS

multiple shunt

revisions

1 week after the second revision

levodopa/carbidopa 100/25 mg TID

parkinsonian features markedly improved/3 days

22

Prashantha et al., 2008 [16]

38/M

obstructive HD due to AS

multiple shunt

revisions

3 days after the last revision

levodopa/carbidopa, total dose 275 mg QID

good response to levodopa/3 weeks; almost asymptomatic/3 months

23

Kinugawa et al., 2009 [13]

49/M

obstructive HD due to AS

VP shunt

3 months after VP shunt

levodopa 300 mg QD trihexyphenidyl 6 mg QD

parkinsonism improved but fully recurred/1 year

24

Sakurai et al., 2010 [19]

46/F

obstructive HD due to AS

VP shunt

unknown

levodopa 600 mg QD

parkinsonian features markedly improved/unknown

25

Hashizume et al., 2011 [10]

47/F

obstructive HD due to AS

VP shunt

1 year after VP shunt

levodopa/carbidopa 1000/100 mg QD endoscopic third ventriculostomy

no improvement with medication; symptoms improved 2 months after surgery

26

Lau et al., 2011 [30]

17/B

obstructive HD due to pineal tumour

VP shunt

3 years after VP shunt

acute shunt

malfunction

total recovery after a month

27

Rebai et al., 2012 [18]

11/F

AS due to tectal tumour

ETV failure,

multiple shunt

revisions

1 day after the last revision

levodopa 125 mg TID bromocriptine 30 mg QD

regained the ability to stand and walk with assistance/2 weeks

28

Okawa et al., 2015 [15]

51/M

obstructive HD due to AS after the bleeding in the fourth ventricle surgery

VP shunt

2 months after VP shunt

levodopa/benserazide 1200/300 mg QD endoscopic third ventriculostomy

preoperative medication for ETV was ineffective; patient was able to walk with a walker after ETV combined with 5 months of medication use

29

Li et al., 2017 [27]

41/M

obstructive HD due to AS

VP shunt

1 month after VP shunt

levodopa/benserazide 200/50 mg TID amantadine 100 mg TID

parkinsonian features markedly improved/10 days

30

35/F

hydrocephalus caused by traumatic brain injury

VP shunt

16 years after VP shunt

levodopa/benserazide 400/100 mg TID

parkinsonian features markedly improved/25 days

31

18/F

hydrocephalus caused by traumatic brain injury

VP shunt

5 months after VP shunt

levodopa/benserazide 100/25 mg TID

could eat independently, increased physical activity/1 month

32

Zhou et al., 2019 [25]

45/M

obstructive HD due to AS

VP shunt and an increase in pressure

6 months after the last revision

Madopar/pramipexole 125/0.125 mg TID for 10 days, Madopar 250 mg TID for two years

parkinsonian features started to improve/10 days; parkinsonian features did not recur/2-year

follow-up period

33

Shpiner et al., 2021 [21]

35/M

obstructive HD due to AS

multiple recalibrations

3 weeks after the last recalibration

carbidopa/levodopa 187.5/750 mg QD, endoscopic third ventriculostomy

presented with parkinsonism/unknown

34

26/M

obstructive HD due to pineal tumour

multiple shunt

revisions

6 months after the last revision

carbidopa/levodopa 75/300 mg QD

presented with parkinsonism /10 days after medication use

35

Costa et al., 2021 [26]

38/M

obstructive HD due to AS

VP shunt

2 weeks after VP shunt

levodopa/benserazide 250 mg QID, bromocriptine 5 mg TID

good control established in 6 months

36

Villamil et al.,2022 [29]

42/F

obstructive HD due to AS

endoscopic third ventriculostomy and VP shunt

2 months after VP shunt

levodopa-carbidopa 250/25 mg QID

after 2 years of follow-up, patient remained on chronic treatment with L-dopa and was responding well

37

32/F

obstructive HD due to rosette-forming glioneuronal tumour

endoscopic third ventriculostomy, VP shunt and shunt revision

4 months after the last revision

levodopa-carbidopa 250/25 mg QID

good control established in 6 months

38

20/M

obstructive HD due to AS

multiple shunt revisions

3 months after the last revision

cabergoline 10 mg QD, amantadine 100 mg TID

completely resolved in 2 months

  1. HD Hydrocephalus, AS Aqueductal stenosis, VP Ventriculoperitoneal, QD Quaque die, BID Bis in die, TID Ter in die; mg = milligrams