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*Depiction of normal CSF flow through the glymphatic system. CSF descends along periarterial perivascular spaces (PVS) and through the interstitium before exiting along perivenular PVS, clearing macromolecules (black particles). The exchange between interstitium and PVS is modulated by astrocytic endfeet expressing AQP4 (pink channels).*
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*An isoattenuating colloid cyst <img src='/img/arrows/WC.png'/> obstructs the foramina of Monro in this 7-year-old, causing obstructive hydrocephalus.*
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*An isoattenuating colloid cyst <img src='img/arrows/WC.png'/> obstructs the foramina of Monro in this 7-year-old, causing obstructive hydrocephalus.*
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*A large suprasellar arachnoid cyst balloons upward <img src='/img/arrows/BS.png'/> and obstructs the foramina of Monro in this 1-year-old with macrocrania.*
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*A large suprasellar arachnoid cyst balloons upward <img src='img/arrows/BS.png'/> and obstructs the foramina of Monro in this 1-year-old with macrocrania.*
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*This 3-month-old with hydrocephalus has a Blake pouch cyst obstructing outflow of CSF from the 4th ventricle. Note the membrane across the posterior foramen magnum <img src='/img/arrows/CC.png'/> and the uplifting of the vermis <img src='/img/arrows/CO.png'/>.*
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*This 3-month-old with hydrocephalus has a Blake pouch cyst obstructing outflow of CSF from the 4th ventricle. Note the membrane across the posterior foramen magnum <img src='img/arrows/CC.png'/> and the uplifting of the vermis <img src='img/arrows/CO.png'/>.*
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*A medulloblastoma <img src='/img/arrows/WO.png'/> fills and obstructs the 4th ventricle in this 10-year-old, leading to supratentorial ventriculomegaly and papilledema <img src='/img/arrows/BS.png'/>. Papilledema visible on MR typically correlates to grade 3 on the Frisen scale (moderate edema).*
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*A medulloblastoma <img src='img/arrows/WO.png'/> fills and obstructs the 4th ventricle in this 10-year-old, leading to supratentorial ventriculomegaly and papilledema <img src='img/arrows/BS.png'/>. Papilledema visible on MR typically correlates to grade 3 on the Frisen scale (moderate edema).*
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*Axial FLAIR MR through the lateral ventricles in the same child shows transependymal edema capping the frontal and occipital horns <img src='/img/arrows/WO.png'/>, reflecting the increased pressure in the ventricular system.*
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*Axial FLAIR MR through the lateral ventricles in the same child shows transependymal edema capping the frontal and occipital horns <img src='img/arrows/WO.png'/>, reflecting the increased pressure in the ventricular system.*
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*Bacterial meningitis (group A Streptococcus in this example) can restrict resorption of CSF but can also obstruct at the cerebral aqueduct and 4th ventricular outlets when complicated by ventriculitis, evident on this image by abnormal enhancement of the ependyma <img src='/img/arrows/WO.png'/>.*
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*Bacterial meningitis (group A Streptococcus in this example) can restrict resorption of CSF but can also obstruct at the cerebral aqueduct and 4th ventricular outlets when complicated by ventriculitis, evident on this image by abnormal enhancement of the ependyma <img src='img/arrows/WO.png'/>.*
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*An infiltrating tectal glioma <img src='/img/arrows/WS.png'/> obstructs the cerebral aqueduct in this 10-year-old. Absence of transependymal edema suggests a compensated hydrocephalus.*
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*An infiltrating tectal glioma <img src='img/arrows/WS.png'/> obstructs the cerebral aqueduct in this 10-year-old. Absence of transependymal edema suggests a compensated hydrocephalus.*
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*A papilloma of the choroid plexus in the occipital horn of the left lateral ventricle <img src='/img/arrows/WS.png'/> causes moderate hydrocephalus by excessive CSF production in this 2-month-old.*
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*A papilloma of the choroid plexus in the occipital horn of the left lateral ventricle <img src='img/arrows/WS.png'/> causes moderate hydrocephalus by excessive CSF production in this 2-month-old.*
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*CSF overproduction can rarely be nonneoplastic in nature, as in this 6-month-old with villous hyperplasia of the choroid plexus in each lateral ventricle <img src='/img/arrows/BS.png'/>. Note the preservation of peripheral sulci, as the unfused sutures of the infant can widen in response to increased intracranial volume.*
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*CSF overproduction can rarely be nonneoplastic in nature, as in this 6-month-old with villous hyperplasia of the choroid plexus in each lateral ventricle <img src='img/arrows/BS.png'/>. Note the preservation of peripheral sulci, as the unfused sutures of the infant can widen in response to increased intracranial volume.*
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### Additional Images
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*Sagittal T1 MR shows a large mass within the 4th ventricle <img src='/img/arrows/BO.png'/> causing intraventricular obstructive hydrocephalus or noncommunicating hydrocephalus.*
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*Sagittal T1 MR shows a large mass within the 4th ventricle <img src='img/arrows/BO.png'/> causing intraventricular obstructive hydrocephalus or noncommunicating hydrocephalus.*
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*Sagittal T2 MR in the same patient shows transependymal CSF flow, seen here as "fingers" extending into white matter around the enlarged lateral ventricle. The case was medulloblastoma with acute IVOH.*
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*Coronal T1 C+ MR shows IVOH with a large, enhancing intraventricular mass <img src='/img/arrows/BS.png'/> causing marked enlargement of the lateral ventricles <img src='/img/arrows/WS.png'/>.*
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*Coronal T1 C+ MR shows IVOH with a large, enhancing intraventricular mass <img src='img/arrows/BS.png'/> causing marked enlargement of the lateral ventricles <img src='img/arrows/WS.png'/>.*
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*Axial NECT in the same patient shows the large intraventricular mass <img src='/img/arrows/BS.png'/> within the 4th ventricle. Note the dilated temporal horns <img src='/img/arrows/WS.png'/>.*
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*Axial NECT in the same patient shows the large intraventricular mass <img src='img/arrows/BS.png'/> within the 4th ventricle. Note the dilated temporal horns <img src='img/arrows/WS.png'/>.*
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*Sagittal T1 MR shows IVOH secondary to aqueductal stenosis and distal stenosis of cerebral aqueduct <img src='/img/arrows/BC.png'/>. Note the enlarged lateral and 3rd ventricles.*
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*Sagittal T1 MR shows IVOH secondary to aqueductal stenosis and distal stenosis of cerebral aqueduct <img src='img/arrows/BC.png'/>. Note the enlarged lateral and 3rd ventricles.*
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*Axial FLAIR MR shows neurosarcoidosis and EVOH secondary to diffuse meningeal disease. Periventricular white matter hyperintensities <img src='/img/arrows/BS.png'/> are also present, as well as choroid involvement <img src='/img/arrows/WO.png'/>.*
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*Axial FLAIR MR shows neurosarcoidosis and EVOH secondary to diffuse meningeal disease. Periventricular white matter hyperintensities <img src='img/arrows/BS.png'/> are also present, as well as choroid involvement <img src='img/arrows/WO.png'/>.*
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*Coronal T1 C+ MR shows neurocysticercosis involvement within the 3rd ventricle and aqueduct <img src='/img/arrows/BS.png'/>, causing IVOH. The lateral ventricles are dilated.*
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*Coronal T1 C+ MR shows neurocysticercosis involvement within the 3rd ventricle and aqueduct <img src='img/arrows/BS.png'/>, causing IVOH. The lateral ventricles are dilated.*
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*Axial FLAIR MR shows neurocysticercosis resulting in IVOH. Large intraventricular cysts are present in the lateral vents <img src='/img/arrows/BS.png'/>, obstructing the foramina of Monro.*
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*Axial FLAIR MR shows neurocysticercosis resulting in IVOH. Large intraventricular cysts are present in the lateral vents <img src='img/arrows/BS.png'/>, obstructing the foramina of Monro.*
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*Axial T1 MR shows a well-defined, hyperintense lesion <img src='/img/arrows/BO.png'/> at the foramen of Monro in a patient with headaches, most consistent with a colloid cyst. Note the enlargement of the lateral ventricles <img src='/img/arrows/BC.png'/> due to obstruction at the foramen of Monro.*
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*Axial T1 MR shows a well-defined, hyperintense lesion <img src='img/arrows/BO.png'/> at the foramen of Monro in a patient with headaches, most consistent with a colloid cyst. Note the enlargement of the lateral ventricles <img src='img/arrows/BC.png'/> due to obstruction at the foramen of Monro.*
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*Sagittal T1 C+ MR shows a homogeneously enhancing mass in the posterior 3rd ventricle <img src='/img/arrows/WO.png'/>, which causes obstruction and dilatation of the lateral and 3rd ventricles. On pathology, this was an astrocytoma.*
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*Sagittal T1 C+ MR shows a homogeneously enhancing mass in the posterior 3rd ventricle <img src='img/arrows/WO.png'/>, which causes obstruction and dilatation of the lateral and 3rd ventricles. On pathology, this was an astrocytoma.*
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*Coronal T2 MR shows a pilocytic astrocytoma centered in the right thalamus <img src='/img/arrows/CO.png'/>, causing severe mass effect on the 3rd ventricle <img src='/img/arrows/CS.png'/> and resultant obstructive hydrocephalus <img src='/img/arrows/WC.png'/>.*
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*Coronal T2 MR shows a pilocytic astrocytoma centered in the right thalamus <img src='img/arrows/CO.png'/>, causing severe mass effect on the 3rd ventricle <img src='img/arrows/CS.png'/> and resultant obstructive hydrocephalus <img src='img/arrows/WC.png'/>.*
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*Axial T2 MR demonstrates a well-defined CSF intensity cyst with the left temporal horn most consistent with an ependymal cyst <img src='/img/arrows/BO.png'/>. Note the dilated and trapped left temporal horn <img src='/img/arrows/BS.png'/>.*
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*Axial T2 MR demonstrates a well-defined CSF intensity cyst with the left temporal horn most consistent with an ependymal cyst <img src='img/arrows/BO.png'/>. Note the dilated and trapped left temporal horn <img src='img/arrows/BS.png'/>.*
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*Sagittal T1 C+ MR shows an enhancing mass in the pineal region <img src='/img/arrows/BS.png'/> causing mass effect on the tectal plate and aqueductal obstruction. Note the extensive leptomeningeal enhancement due to CSF spread of tumor. CSF cytology showed a primitive neuroectodermal tumor.*
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*Sagittal T1 C+ MR shows an enhancing mass in the pineal region <img src='img/arrows/BS.png'/> causing mass effect on the tectal plate and aqueductal obstruction. Note the extensive leptomeningeal enhancement due to CSF spread of tumor. CSF cytology showed a primitive neuroectodermal tumor.*
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*A medulloblastoma <img src='/img/arrows/WO.png'/> fills and obstructs the 4th ventricle in this 10-year-old, leading to supratentorial ventriculomegaly and papilledema.*
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*A medulloblastoma <img src='img/arrows/WO.png'/> fills and obstructs the 4th ventricle in this 10-year-old, leading to supratentorial ventriculomegaly and papilledema.*
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*FIESTA shows pineal parenchymal tumor of intermediate differentiation <img src='/img/arrows/WO.png'/> obstructing the cerebral aqueduct in this 8-year-old boy.*
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*FIESTA shows pineal parenchymal tumor of intermediate differentiation <img src='img/arrows/WO.png'/> obstructing the cerebral aqueduct in this 8-year-old boy.*
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