Syndrome of progressive spastic ataxia and apraxia associated with occult hydrocephalus

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Abstract
The diagnostic possibilities of occult hydrocephalus are discussed including one aspect of this syndrome which has not previously been defined, namely, spastic ataxia and spastic apraxia of gait. Recognition of the syndrome by attention to its various manifestations and distinction of these manifestations from conditions which they may simulate can lead to an earlier diagnosis of internal hydrocephalus. The early manifestations of certain intracranial neoplasms may actually be the referred symptomatology of an associated internal hydrocephalus. Only later do signs of direct involvement or severe pressure phenomena appear to give the classic picture of brain tumor. Conversely, many patients presenting signs suggesting mass lesions might well have an obstructive hydrocephalus due to some unsuspected interference in the subarachnoid channel pathways or cerebrospinal fluid circulation, where the etiology is forgotten and diagnosis is difficult to establish even at postmortem. Clinical conditions produced by such processes may be readily reversible by shunting procedures.

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