In this report, we describe a 75-year-old male with a 4-month onset of a shuffling gait. Additionally, he has had multiple near falls with freezing of gait and start hesitation. Magnetic resonance imaging of the brain revealed severe narrowing of the aqueduct at the level of the inferior colliculus, alongside enlargement of the lateral ventricles and the third ventricle. Notably, a small web-like projection was observed at the site of greatest narrowing, indicative of an aqueductal web. Further analysis of cerebrospinal fluid flow dynamics confirmed a high degree of aqueductal stenosis attributed to the aqueductal web previously identified.
Subsequently, the patient was referred to Neurosurgery and underwent a successful endoscopic third ventriculostomy. Two days post-surgery, the patient demonstrated improved stability in walking with minimal shuffling.