Supplementary Material for: A case of aqueductal stenosis with bilateral papilledema and abducens nerve palsies without headache

Introduction: We report a case of aqueductal stenosis presenting with bilateral papilledema and diplopia, notably without headache.
Case Presentation: A 16-year-old girl with no relevant medical history presented with a one-week history of binocular diplopia without any loss of visual acuity in either eye. At the time of her visit, she had no symptoms of headache or vomiting. Examination of eye movements revealed bilateral abduction deficits and fundoscopic examination showed bilateral optic disc swelling. Non-contrast computed tomography of the head indicated hydrocephalus. Contrast-enhanced magnetic resonance imaging of the head revealed significant dilatation of the lateral and third ventricles but not in the fourth ventricle. Sagittal T2-weighted imaging with constructive interference in the steady state showed membranous occlusion of the cerebral aqueduct. The patient underwent an endoscopic third ventriculostomy. Binocular diplopia improved during the early postoperative period.
Conclusion: Aqueductal stenosis should be considered in the differential diagnosis for patients presenting with bilateral papilledema and abducens nerve palsies, even in the absence of headache or other neurological findings.