{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T16:53:38Z","timestamp":1782320018636,"version":"3.54.5"},"reference-count":32,"publisher":"BMJ","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Neurology, Neurosurgery & Psychiatry"],"published-print":{"date-parts":[[1974,1,1]]},"DOI":"10.1136\/jnnp.37.1.21","type":"journal-article","created":{"date-parts":[[2008,11,10]],"date-time":"2008-11-10T21:02:42Z","timestamp":1226350962000},"page":"21-26","source":"Crossref","is-referenced-by-count":37,"title":["Periaqueductal dysfunction (the Sylvian aqueduct syndrome): a sign of hydrocephalus?"],"prefix":"10.1136","volume":"37","author":[{"given":"M.","family":"Swash","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","reference":[{"key":"ref_1","article-title":"Since periaqueductal glial and ependymal changes similar to those found in these previously reported cases are present in many cases of aqueductal stenosis without such striking ocular signs","volume-title":"the ocular findings cannot be attributed directly to these changes alone. Furthermore, in most such cases, as in the present case, the ocular signs are most prominent when hydrocephalus is decompensated","year":"1949","unstructured":"Since periaqueductal glial and ependymal changes similar to those found in these previously reported cases are present in many cases of aqueductal stenosis without such striking ocular signs (Russell, 1949), the ocular findings cannot be attributed directly to these changes alone. Furthermore, in most such cases, as in the present case, the ocular signs are most prominent when hydrocephalus is decompensated."},{"key":"ref_2","article-title":"These observations provide evidence indicating that the ocular abnormalities found in these patients are due to dilatation and assimilation of the rostral part of the aqueduct, particularly when there is associated uncal herniation and axial displacement of the third ventricle, causing secondary compression of this region of the brain-stem. It follows that these ocular signs should occur more frequently in hydrocephalus due to aqueduct stenosis than in communicating hydrocephalus, since, in the latter, aqueductal dilatation and assimilation is usually slight, and uncal herniation with compression of the upper brain-stem is less likely to occur. Indeed, ocular signs consistent with rostral periaqueductal dysfunction did not occur in the series of cases of adult-onset, communicating hydrocephalus described by Foltz and","author":"Messert and Baker (1966), and Hill et al.","year":"1956","unstructured":"These observations provide evidence indicating that the ocular abnormalities found in these patients are due to dilatation and assimilation of the rostral part of the aqueduct, particularly when there is associated uncal herniation and axial displacement of the third ventricle, causing secondary compression of this region of the brain-stem. It follows that these ocular signs should occur more frequently in hydrocephalus due to aqueduct stenosis than in communicating hydrocephalus, since, in the latter, aqueductal dilatation and assimilation is usually slight, and uncal herniation with compression of the upper brain-stem is less likely to occur. Indeed, ocular signs consistent with rostral periaqueductal dysfunction did not occur in the series of cases of adult-onset, communicating hydrocephalus described by Foltz and Ward (1956), McHugh (1964), Hakim and Adams (1965), Messert and Baker (1966), and Hill et al. (1967).","journal-title":"Hakim and Adams"},{"key":"ref_3","article-title":"it should be noted that ocular signs similar to those under discussion are a common presenting feature of infantile hydrocephalus. In many of these infants hydrocephalus is due to congenital or acquired aqueductal stenosis","author":"Finally","year":"1949","unstructured":"Finally, it should be noted that ocular signs similar to those under discussion are a common presenting feature of infantile hydrocephalus. In many of these infants hydrocephalus is due to congenital or acquired aqueductal stenosis (Russell, 1949; Ford, 1966)."},{"key":"ref_4","article-title":"The occurrence of ocular signs in these infants is thus consistent with the hypothesis, although this is not their usually accepted explanation (Ford, 1966; Walsh and Hoyt, 1969). Further attempts to correlate the ocular signs with radiographic abnormalities of the rostral aqueduct should be made in such cases","unstructured":"The occurrence of ocular signs in these infants is thus consistent with the hypothesis, although this is not their usually accepted explanation (Ford, 1966; Walsh and Hoyt, 1969). Further attempts to correlate the ocular signs with radiographic abnormalities of the rostral aqueduct should be made in such cases."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1001\/archneurpsyc.1953.02320260094007","article-title":"Retraction nystagmus and retraction of eyelids due to arteriovenous aneurysm of midbrain","volume":"69","author":"Askenasy, H.; Wijsenbeek, H.; Herzberger, E.","year":"1953","unstructured":"Askenasy, H., Wijsenbeek, H., and Herzberger, E. (1953). Retraction nystagmus and retraction of eyelids due to arteriovenous aneurysm of midbrain. Archives ofNeitrology and Psychiatry, 69, 236-241.","journal-title":"Archives ofNeitrology and Psychiatry"},{"key":"ref_6","author":"Beckett, R.S.; Netsky, M.G.; Zimmerman, H.M.","year":"1950","unstructured":"Beckett, R. S., Netsky, M. G., and Zimmerman, H. M. (1950)."},{"key":"ref_7","first-page":"29","article-title":"Convergence and retractory nystagmus","volume":"85","author":"Christoff, N.; Anderson, P.J.; Bender, M.B.","year":"1960","unstructured":"Christoff, N., Anderson, P. J., and Bender, M. B. (1960). Convergence and retractory nystagmus. Transactionis of the American Neutrological Association, 85, 29-32.","journal-title":"Transactionis of the American Neutrological Association"},{"key":"ref_8","article-title":"Nelurology of the Octular Muiscles","author":"Cogan, D.G.","year":"1956","unstructured":"Cogan, D. G. (1956). Nelurology of the Octular Muiscles. 2nd edn. Thomas: Springfield.","edition":"2nd edn"},{"key":"ref_9","article-title":"Nystagmus retractorius, ein cerebrales","author":"Elschnig, A.","year":"1913","unstructured":"Elschnig, A. (1913). Nystagmus retractorius, ein cerebrales"},{"key":"ref_10","first-page":"546","article-title":"Communicating hydrocephalus from subarachnoid bleeding","volume":"13","author":"Foltz, E.L.; Ward, Jr, A.A.","year":"1956","unstructured":"Foltz, E. L., and Ward, A. A., Jr. (1956). Communicating hydrocephalus from subarachnoid bleeding. Joutrnal of Neutrosuirgery, 13, 546-566.","journal-title":"Joutrnal of Neutrosuirgery"},{"key":"ref_11","first-page":"32","article-title":"Diseases of the Nervouis System in Itnfancy, Childhood, and Adolescence","volume":"16","author":"Ford, F.R.","year":"1966","unstructured":"Ford, F. R. (1966). Diseases of the Nervouis System in Itnfancy, Childhood, and Adolescence. 5th edn. Thomas: Springfield, Ill. Fredericks, E. J., and Van Nuis, C. (1967). Diverticulum of the rostral cerebra! aqueduct with ocular dysfunctions. Archives of Neurology, 16, 32-36.","edition":"5th edn","journal-title":"Archives of Neurology; Diverticulum of the rostral cerebra! aqueduct with ocular dysfunctions"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1097\/00005072-194610000-00006","article-title":"Atresia and stenosis of the aqueduct of Sylvius","volume":"5","author":"Globus, J.H.; Bergman, P.","year":"1946","unstructured":"Globus, J. H., and Bergman, P. (1946). Atresia and stenosis of the aqueduct of Sylvius. Jouirnal of Neutropathology and Experimental Nelurology, 5, 342-363.","journal-title":"Jouirnal of Neutropathology and Experimental Nelurology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/0022-510X(65)90016-X","article-title":"The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure","volume":"2","author":"Hakim, S.; Adams, R.D.","year":"1965","unstructured":"Hakim, S., and Adams, R. D. (1965). The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Jouirnal of the Neutrological Sciences, 2, 307-327.","journal-title":"Jouirnal of the Neutrological Sciences"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1001\/archneur.1966.00470140105015","article-title":"The Sylvian aqueduct syndrome","volume":"15","author":"Hatcher, Jr., M.A.; Klintworth, G.K.","year":"1966","unstructured":"Hatcher, M. A., Jr., and Klintworth, G. K. (1966). The Sylvian aqueduct syndrome. Archives of Neurology, 15, 215-222.","journal-title":"Archives of Neurology"},{"key":"ref_15","author":"Hill, M.E.; Lougheed, W.M.; Barnett, H.J.M.","year":"1967","unstructured":"Hill, M. E., Lougheed, W. M., and Barnett, H. J. M. (1967)."},{"key":"ref_16","first-page":"1309","article-title":"A treatable form of dementia due to normal-pressure, communicating hydrocephalus","volume":"97","unstructured":"A treatable form of dementia due to normal-pressure, communicating hydrocephalus. Canadian Medical Association Journal, 97, 1309-1320.","journal-title":"Canadian Medical Association Journal"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1136\/jnnp.35.1.114","article-title":"Axial enlargement of the 3rd ventricle, and displacement of the brain-stem in benign aqueduct stenosis","volume":"35","author":"Jakubowski, J.; Jefferson, A.","year":"1972","unstructured":"Jakubowski, J., and Jefferson, A. (1972). Axial enlargement of the 3rd ventricle, and displacement of the brain-stem in benign aqueduct stenosis. Jouirnal of Neurology, Neurosutrgery, and Psychiatry, 35, 114-123.","journal-title":"Jouirnal of Neurology, Neurosutrgery, and Psychiatry"},{"key":"ref_18","article-title":"Clinical Methods of Neuro-Ophthalmologic Examination","author":"Kestenbaum, A.","year":"1961","unstructured":"Kestenbaum, A. (1961). Clinical Methods of Neuro-Ophthalmologic Examination. 2nd edn. Grune and Stratton: New York.","edition":"2nd edn."},{"key":"ref_19","article-title":"Cited by D. G. Cogan in Neuirology of the Ocutlar Mutscles","author":"Koerber, H.","year":"1956","unstructured":"Koerber, H. (1956). Cited by D. G. Cogan in Neuirology of the Ocutlar Mutscles, 2nd edn. Springfield, I11.","edition":"2nd edn"},{"key":"ref_20","first-page":"297","article-title":"Occult hydrocephalus","volume":"33","author":"McHugh, P.R.","year":"1964","unstructured":"McHugh, P. R. (1964). Occult hydrocephalus. Quarterly Joutrnal of Medicine, 33, 297-308.","journal-title":"Quarterly Joutrnal of Medicine"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1212\/WNL.16.5.440","article-title":"Syndrome of progressive spastic ataxia and apraxia associated with occult hydrocephalus","volume":"16","author":"Messert, B.; Baker, N.H.","year":"1966","unstructured":"Messert, B., and Baker, N. H. (1966). Syndrome of progressive spastic ataxia and apraxia associated with occult hydrocephalus. Neuirology (Minneapolis), 16, 440-452.","journal-title":"Neuirology (Minneapolis)"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1093\/brain\/46.2.179","article-title":"Rhythmical convergence spasm of the eyes in a case of tumour of the pineal gland","volume":"46","author":"Monchy, S.J.R.de","year":"1923","unstructured":"Monchy, S. J. R. de (1923). Rhythmical convergence spasm of the eyes in a case of tumour of the pineal gland. Brain, 46, 179-188.","journal-title":"Brain"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1136\/bmj.2.5523.1168","article-title":"Non-tumoral stenosis of the aqueduct in adults","volume":"2","author":"Nag, T.K.; Falconer, M.A.","year":"1966","unstructured":"Nag, T. K., and Falconer, M. A. (1966). Non-tumoral stenosis of the aqueduct in adults. British Medical Jouirnal, 2, 1168-1170.","journal-title":"British Medical Jouirnal"},{"key":"ref_24","first-page":"227","article-title":"Convergence nystagmus and paralysis of vertical gaze following balloonmade lesion for Parkinsonism. Sequence of events during recovery","volume":"87","author":"Nathanson, M.; Epstein, J.A.","year":"1962","unstructured":"Nathanson, M., and Epstein, J. A. (1962). Convergence nystagmus and paralysis of vertical gaze following balloonmade lesion for Parkinsonism. Sequence of events during recovery. 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Revue Neurologique, 82, 417-421.","journal-title":"Revue Neurologique"},{"key":"ref_27","article-title":"Observations on the Pathology of Hydrocephalus","volume":"265","author":"Russell, D.S.","year":"1949","unstructured":"Russell, D. S. (1949). Observations on the Pathology of Hydrocephalus. Medical Research Council Special Report Series No. 265. H.M.S.O.: London.","journal-title":"Medical Research Council Special Report Series"},{"key":"ref_28","first-page":"34","article-title":"On acquired retraction movements of the eyes","volume":"42","author":"Salus, -R","year":"1913","unstructured":"Salus,-R. (1913). On acquired retraction movements of the eyes. Archives of Ophthalmology, 42, 34-44.","journal-title":"Archives of Ophthalmology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1212\/WNL.11.10.883","volume":"11","author":"Segarra, J.M.; Ojeman, R.J.","year":"1961","unstructured":"Segarra, J. M., and Ojeman, R. J. (1961). Convergence nystagmus. 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