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### Selected Images
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**CSF Shunts and Complications**
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*Axial T2 MR in a patient with chronic shunting demonstrates slit-like irregular lateral ventricles <img src='/img/arrows/CS.png'/> due to noncompliance from chronic drainage.*
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*Axial T2 MR in a patient with chronic shunting demonstrates slit-like irregular lateral ventricles <img src='img/arrows/CS.png'/> due to noncompliance from chronic drainage.*
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**Surgical Defects**
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*Axial FLAIR MR demonstrates a large surgical defect in the left frontal lobe <img src='/img/arrows/CS.png'/> due to prior tumor resection communicating with the left lateral ventricle <img src='/img/arrows/CO.png'/>, which appears irregular.*
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*Axial FLAIR MR demonstrates a large surgical defect in the left frontal lobe <img src='img/arrows/CS.png'/> due to prior tumor resection communicating with the left lateral ventricle <img src='img/arrows/CO.png'/>, which appears irregular.*
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**Periventricular Leukomalacia**
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*Axial T2 MR in a 5-year-old boy with spastic cerebral palsy demonstrates irregular lateral ventricles <img src='/img/arrows/CO.png'/> with paucity of white matter and periventricular hyperintensities <img src='/img/arrows/CS.png'/>, consistent with periventricular leukomalacia.*
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*Axial T2 MR in a 5-year-old boy with spastic cerebral palsy demonstrates irregular lateral ventricles <img src='img/arrows/CO.png'/> with paucity of white matter and periventricular hyperintensities <img src='img/arrows/CS.png'/>, consistent with periventricular leukomalacia.*
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**Cerebral Infarction, Chronic**
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*Axial T2 MR demonstrates encephalomalacia in the left occipital lobe <img src='/img/arrows/CO.png'/> with ex vacuo dilation of left occipital horn <img src='/img/arrows/CS.png'/> due to PCA territory chronic infarct.*
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*Axial T2 MR demonstrates encephalomalacia in the left occipital lobe <img src='img/arrows/CO.png'/> with ex vacuo dilation of left occipital horn <img src='img/arrows/CS.png'/> due to PCA territory chronic infarct.*
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**Multiple Sclerosis**
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*Axial T2 MR in a patient with primary progressive MS demonstrates extensive white matter hyperintensities <img src='/img/arrows/CS.png'/> with asymmetric parenchymal volume loss and ex vacuo dilation of lateral ventricles <img src='/img/arrows/CO.png'/>.*
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*Axial T2 MR in a patient with primary progressive MS demonstrates extensive white matter hyperintensities <img src='img/arrows/CS.png'/> with asymmetric parenchymal volume loss and ex vacuo dilation of lateral ventricles <img src='img/arrows/CO.png'/>.*
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**Porencephalic Cyst**
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*Axial T2 MR demonstrates a right occipital lobe, smooth-walled, cystic encephalomalacia <img src='/img/arrows/CO.png'/> lined by white matter <img src='/img/arrows/CS.png'/> and communicating with the lateral ventricle, consistent with porencephalic cyst.*
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*Axial T2 MR demonstrates a right occipital lobe, smooth-walled, cystic encephalomalacia <img src='img/arrows/CO.png'/> lined by white matter <img src='img/arrows/CS.png'/> and communicating with the lateral ventricle, consistent with porencephalic cyst.*
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**Chiari 2**
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*Axial NECT demonstrates irregular lateral ventricles <img src='/img/arrows/CO.png'/> with a right frontal lobe shunt catheter <img src='/img/arrows/CS.png'/>. Note diffuse calvarial thickening <img src='/img/arrows/CC.png'/> due to chronic shunting. Images of posterior fossa revealed small posterior fossa and other stigmata of Chiari 2 malformation (not shown).*
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*Axial NECT demonstrates irregular lateral ventricles <img src='img/arrows/CO.png'/> with a right frontal lobe shunt catheter <img src='img/arrows/CS.png'/>. Note diffuse calvarial thickening <img src='img/arrows/CC.png'/> due to chronic shunting. Images of posterior fossa revealed small posterior fossa and other stigmata of Chiari 2 malformation (not shown).*
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**Heterotopic Gray Matter**
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*Axial T2 MR demonstrates nodular gray matter heterotopia <img src='/img/arrows/CS.png'/> along the ependymal lining of bilateral occipital horns.*
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*Axial T2 MR demonstrates nodular gray matter heterotopia <img src='img/arrows/CS.png'/> along the ependymal lining of bilateral occipital horns.*
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**Tuberous Sclerosis Complex**
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*Axial 3D T1 MPRAGE in a patient with known tuberous sclerosis demonstrates multiple subependymal nodules <img src='/img/arrows/CS.png'/>. Also note tiny cysts in white matter <img src='/img/arrows/CO.png'/>. Cortical/ subcortical tubers and white matter radial migration lines were seen (not shown).*
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*Axial 3D T1 MPRAGE in a patient with known tuberous sclerosis demonstrates multiple subependymal nodules <img src='img/arrows/CS.png'/>. Also note tiny cysts in white matter <img src='img/arrows/CO.png'/>. Cortical/ subcortical tubers and white matter radial migration lines were seen (not shown).*
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**Metastases, Intracranial, Other**
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*Axial T1 C+ MR in a patient with metastatic lung cancer demonstrates multiple heterogeneously enhancing metastatic lesions in bilateral periventricular regions <img src='/img/arrows/CS.png'/>.*
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*Axial T1 C+ MR in a patient with metastatic lung cancer demonstrates multiple heterogeneously enhancing metastatic lesions in bilateral periventricular regions <img src='img/arrows/CS.png'/>.*
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**Intraventricular Webs or Adhesions**
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*Axial 3D T2 HASTE MR in a neonate demonstrates multiple septa/webs in both lateral ventricles <img src='/img/arrows/CS.png'/>. Also note asymmetrically dilated, irregular lateral ventricles <img src='/img/arrows/CC.png'/>. Encephalomalacia in the right parietooccipital region <img src='/img/arrows/CO.png'/> is due to antenatal insult.*
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*Axial 3D T2 HASTE MR in a neonate demonstrates multiple septa/webs in both lateral ventricles <img src='img/arrows/CS.png'/>. Also note asymmetrically dilated, irregular lateral ventricles <img src='img/arrows/CC.png'/>. Encephalomalacia in the right parietooccipital region <img src='img/arrows/CO.png'/> is due to antenatal insult.*
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**CMV, Congenital**
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*Axial NECT in a 2-year-old with a known congenital CMV infection demonstrates moderately dilated irregular lateral ventricles <img src='/img/arrows/CS.png'/> as well as periventricular and deep white matter calcifications <img src='/img/arrows/CC.png'/>. Note lissencephalic gyral pattern <img src='/img/arrows/CO.png'/>.*
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*Axial NECT in a 2-year-old with a known congenital CMV infection demonstrates moderately dilated irregular lateral ventricles <img src='img/arrows/CS.png'/> as well as periventricular and deep white matter calcifications <img src='img/arrows/CC.png'/>. Note lissencephalic gyral pattern <img src='img/arrows/CO.png'/>.*
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**Schizencephaly**
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*Axial 3D T1 MR demonstrates open-lip schizencephaly with a seam connecting ependymal to pial surface <img src='/img/arrows/CS.png'/>. Note gray matter lining the cystic area <img src='/img/arrows/CO.png'/>, differentiating it from a porencephalic cyst.*
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*Axial 3D T1 MR demonstrates open-lip schizencephaly with a seam connecting ependymal to pial surface <img src='img/arrows/CS.png'/>. Note gray matter lining the cystic area <img src='img/arrows/CO.png'/>, differentiating it from a porencephalic cyst.*
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**Holoprosencephaly Variants**
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*Axial T2 MR demonstrates absent septum <img src='/img/arrows/CS.png'/> with absent posterior body of corpus callosum. Also seen was abnormal bilateral sylvian fissure with ventricle orientation and midline fusion (not shown), consistent with syntelencephaly, a.k.a. middle interhemispheric variant holoprosencephaly.*
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*Axial T2 MR demonstrates absent septum <img src='img/arrows/CS.png'/> with absent posterior body of corpus callosum. Also seen was abnormal bilateral sylvian fissure with ventricle orientation and midline fusion (not shown), consistent with syntelencephaly, a.k.a. middle interhemispheric variant holoprosencephaly.*
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### Additional Images
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**CSF Shunts and Complications**
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*Axial NECT shows a right frontal ventricular drain that traverses the right ventricle but is not decompressing the left lateral ventricle, which remains irregularly enlarged <img src='/img/arrows/WC.png'/>.*
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*Axial NECT shows a right frontal ventricular drain that traverses the right ventricle but is not decompressing the left lateral ventricle, which remains irregularly enlarged <img src='img/arrows/WC.png'/>.*
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**Surgical Defects**
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*Axial T2 MR shows irregular enlargement of the left occipital horn <img src='/img/arrows/WS.png'/> due to left temporal and occipital surgical defect and encephalomalacia from tumor removal in this location.*
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*Axial T2 MR shows irregular enlargement of the left occipital horn <img src='img/arrows/WS.png'/> due to left temporal and occipital surgical defect and encephalomalacia from tumor removal in this location.*
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**Periventricular Leukomalacia**
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*Axial T2 MR shows classic "wavy" or undulating contours of the lateral ventricles <img src='/img/arrows/WS.png'/> in addition to colpocephaly (enlargement of the posterior portions of lateral ventricles). Colpocephaly reflects the predominantly posterior volume loss.*
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*Axial T2 MR shows classic "wavy" or undulating contours of the lateral ventricles <img src='img/arrows/WS.png'/> in addition to colpocephaly (enlargement of the posterior portions of lateral ventricles). Colpocephaly reflects the predominantly posterior volume loss.*
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**Cerebral Infarction, Chronic**
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*Axial NECT shows irregular enlargement of the left frontal horn <img src='/img/arrows/WO.png'/> due to focal regional parenchymal volume loss in this patient with remote MCA infarct.*
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*Axial NECT shows irregular enlargement of the left frontal horn <img src='img/arrows/WO.png'/> due to focal regional parenchymal volume loss in this patient with remote MCA infarct.*
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**Heterotopic Gray Matter**
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*Axial T1 FS MR shows multifocal nodularity along ependymal margins of both lateral ventricles <img src='/img/arrows/WS.png'/>. These nodules follow gray matter signal on all sequences and do not enhance or change over time.*
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*Axial T1 FS MR shows multifocal nodularity along ependymal margins of both lateral ventricles <img src='img/arrows/WS.png'/>. These nodules follow gray matter signal on all sequences and do not enhance or change over time.*
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**Chiari 2**
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*Axial NECT shows irregularly dilated occipital horns <img src='/img/arrows/WS.png'/> with interdigitation of parietal and occipital parenchyma across midline <img src='/img/arrows/WC.png'/> due to a falx deficiency.*
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*Axial NECT shows irregularly dilated occipital horns <img src='img/arrows/WS.png'/> with interdigitation of parietal and occipital parenchyma across midline <img src='img/arrows/WC.png'/> due to a falx deficiency.*
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**Chiari 2**
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*Coronal T2 MR shows dysgenetic corpus callosum, small posterior fossa, and interdigitation of gyri <img src='/img/arrows/WS.png'/> from deficient falx, best seen post shunting. Cerebellum "towers" through the tentorial notch.*
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*Coronal T2 MR shows dysgenetic corpus callosum, small posterior fossa, and interdigitation of gyri <img src='img/arrows/WS.png'/> from deficient falx, best seen post shunting. Cerebellum "towers" through the tentorial notch.*
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**Tuberous Sclerosis Complex**
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*Axial T2 MR shows multiple calcified subependymal nodules (SEN) <img src='/img/arrows/WS.png'/> lining ventricles. Note also subcortical tubers <img src='/img/arrows/WC.png'/>. SEN calcify much more commonly than cortical/subcortical tubers. ~ 50% of SEN are calcified by 10 years.*
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*Axial T2 MR shows multiple calcified subependymal nodules (SEN) <img src='img/arrows/WS.png'/> lining ventricles. Note also subcortical tubers <img src='img/arrows/WC.png'/>. SEN calcify much more commonly than cortical/subcortical tubers. ~ 50% of SEN are calcified by 10 years.*
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**Tuberous Sclerosis Complex**
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*Axial T2 MR shows small, subependymal nodules <img src='/img/arrows/WS.png'/>, which indent lateral ventricle margins. Unlike gray matter heterotopia, these follow WM signal or are calcified.*
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*Axial T2 MR shows small, subependymal nodules <img src='img/arrows/WS.png'/>, which indent lateral ventricle margins. Unlike gray matter heterotopia, these follow WM signal or are calcified.*
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**Metastases, Intracranial, Other**
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*Axial T1 MR shows nodular ependymal thickening with an enhancing rind of tissue along the entire ventricular ependyma <img src='/img/arrows/WS.png'/>. While infection & primary malignant brain neoplasms such as GBM, germinoma, and lymphoma commonly spread along ventricular ependyma, this is a recognized but uncommon site for tumor deposits from extracranial primary tumors (melanoma in this case).*
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*Axial T1 MR shows nodular ependymal thickening with an enhancing rind of tissue along the entire ventricular ependyma <img src='img/arrows/WS.png'/>. While infection & primary malignant brain neoplasms such as GBM, germinoma, and lymphoma commonly spread along ventricular ependyma, this is a recognized but uncommon site for tumor deposits from extracranial primary tumors (melanoma in this case).*
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**Schizencephaly**
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*Axial T2 MR shows a small dimple on the lateral ventricular wall, which "points" to the site of a fused pial-ependymal seam <img src='/img/arrows/BS.png'/>. The aperture of the cleft is lined by gray matter <img src='/img/arrows/WO.png'/> in this closed-lip schizencephaly.*
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*Axial T2 MR shows a small dimple on the lateral ventricular wall, which "points" to the site of a fused pial-ependymal seam <img src='img/arrows/BS.png'/>. The aperture of the cleft is lined by gray matter <img src='img/arrows/WO.png'/> in this closed-lip schizencephaly.*
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**Schizencephaly**
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*Axial T2 MR shows cortical dysplasia and open-lip schizencephaly <img src='/img/arrows/WS.png'/>. Schizencephaly is closed-lip with a fused, gray matter-lined pial-ependymal seam or open-lip with large, gray matter-lined and fluid-filled CSF clefts.*
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*Axial T2 MR shows cortical dysplasia and open-lip schizencephaly <img src='img/arrows/WS.png'/>. Schizencephaly is closed-lip with a fused, gray matter-lined pial-ependymal seam or open-lip with large, gray matter-lined and fluid-filled CSF clefts.*
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**Schizencephaly**
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*Axial NECT shows focal outpouchings of CSF from both lateral ventricles <img src='/img/arrows/WS.png'/> with a CSF cleft extending from lateral ventricles to the subpial surface. The pial-ependymal seam is lined by gray matter.*
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*Axial NECT shows focal outpouchings of CSF from both lateral ventricles <img src='img/arrows/WS.png'/> with a CSF cleft extending from lateral ventricles to the subpial surface. The pial-ependymal seam is lined by gray matter.*
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**Holoprosencephaly**
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*Axial NECT shows septum pellucidum and anterior falx absence. Frontal horns are hypoplastic. A band of parenchyma crosses midline <img src='/img/arrows/WS.png'/>. Mild frontal lobe fusion anomalies, as seen here, are typical of lobar holoprosencephaly.*
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*Axial NECT shows septum pellucidum and anterior falx absence. Frontal horns are hypoplastic. A band of parenchyma crosses midline <img src='img/arrows/WS.png'/>. Mild frontal lobe fusion anomalies, as seen here, are typical of lobar holoprosencephaly.*
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**Schizencephaly**
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*Axial T1 MR shows open-lip schizencephaly with large, gray matter-lined <img src='/img/arrows/CS.png'/> and a fluid-filled CSF cleft. In addition, there is ventricular wall irregularity due to subependymal gray matter heterotopia bilaterally <img src='/img/arrows/CO.png'/>.*
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*Axial T1 MR shows open-lip schizencephaly with large, gray matter-lined <img src='img/arrows/CS.png'/> and a fluid-filled CSF cleft. In addition, there is ventricular wall irregularity due to subependymal gray matter heterotopia bilaterally <img src='img/arrows/CO.png'/>.*
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**Schizencephaly**
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*Coronal T2 MR demonstrates closed-lip schizencephaly. Abnormal, thick gray matter <img src='/img/arrows/CS.png'/> lines the cleft extending to a dimple in the wall of the right lateral ventricle <img src='/img/arrows/BS.png'/>.*
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*Coronal T2 MR demonstrates closed-lip schizencephaly. Abnormal, thick gray matter <img src='img/arrows/CS.png'/> lines the cleft extending to a dimple in the wall of the right lateral ventricle <img src='img/arrows/BS.png'/>.*
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**Tuberous Sclerosis Complex**
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*Axial CT shows multiple calcified subependymal nodules <img src='/img/arrows/CS.png'/> lining the ventricles in a patient with tuberous sclerosis. The nodules calcify much more commonly than cortical/subcortical tubers. Note traumatic subarachnoid hemorrhage <img src='/img/arrows/BS.png'/> in the left Sylvian fissure.*
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*Axial CT shows multiple calcified subependymal nodules <img src='img/arrows/CS.png'/> lining the ventricles in a patient with tuberous sclerosis. The nodules calcify much more commonly than cortical/subcortical tubers. Note traumatic subarachnoid hemorrhage <img src='img/arrows/BS.png'/> in the left Sylvian fissure.*
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**Heterotopic Gray Matter**
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*Axial T2 MR shows multiple bilateral subependymal nodules of heterotopic gray matter <img src='/img/arrows/CS.png'/> along the lateral ventricular margins. These nodules follow gray matter signal on all sequences.*
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*Axial T2 MR shows multiple bilateral subependymal nodules of heterotopic gray matter <img src='img/arrows/CS.png'/> along the lateral ventricular margins. These nodules follow gray matter signal on all sequences.*
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**Chiari 2**
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*Axial CT in a Chiari 2 patient shows typical irregular appearance of the ventricles. Note the left posterior shunt catheter <img src='/img/arrows/CS.png'/>.*
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*Axial CT in a Chiari 2 patient shows typical irregular appearance of the ventricles. Note the left posterior shunt catheter <img src='img/arrows/CS.png'/>.*
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**Cerebral Infarction, Chronic**
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*Axial FLAIR MR demonstrates left posterior middle cerebral artery encephalomalacia <img src='/img/arrows/CS.png'/> with mild ex vacuo dilatation of the left occipital horn and atrium <img src='/img/arrows/CO.png'/>.*
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*Axial FLAIR MR demonstrates left posterior middle cerebral artery encephalomalacia <img src='img/arrows/CS.png'/> with mild ex vacuo dilatation of the left occipital horn and atrium <img src='img/arrows/CO.png'/>.*
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**Periventricular Leukomalacia**
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*Axial T2 MR in periventricular leukomalacia shows asymmetric, posterior, periventricular white matter (WM) volume loss with irregular ventricular margins <img src='/img/arrows/CS.png'/>. Periventricular leukomalacia, a.k.a. WM injury of prematurity, is a result of brain injury occurring before 33 weeks gestation and resulting in loss of periventricular WM.*
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*Axial T2 MR in periventricular leukomalacia shows asymmetric, posterior, periventricular white matter (WM) volume loss with irregular ventricular margins <img src='img/arrows/CS.png'/>. Periventricular leukomalacia, a.k.a. WM injury of prematurity, is a result of brain injury occurring before 33 weeks gestation and resulting in loss of periventricular WM.*
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**Surgical Defects**
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*Axial FIESTA MR in a patient following left temporal bone surgery shows skull defect <img src='/img/arrows/CS.png'/>, underlying encephalomalacia <img src='/img/arrows/CO.png'/>, and ex vacuo dilatation of the left lateral ventricle <img src='/img/arrows/BS.png'/>.*
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*Axial FIESTA MR in a patient following left temporal bone surgery shows skull defect <img src='img/arrows/CS.png'/>, underlying encephalomalacia <img src='img/arrows/CO.png'/>, and ex vacuo dilatation of the left lateral ventricle <img src='img/arrows/BS.png'/>.*
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**CSF Shunts and Complications**
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*Axial T1 MR demonstrates a right parietal shunt catheter with its tip <img src='/img/arrows/CS.png'/> in the right frontal horn in a patient with congenital aqueductal stenosis. The right lateral ventricle is collapsed, while the 3rd <img src='/img/arrows/CO.png'/> and left lateral ventricles <img src='/img/arrows/CC.png'/> are moderately dilated.*
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*Axial T1 MR demonstrates a right parietal shunt catheter with its tip <img src='img/arrows/CS.png'/> in the right frontal horn in a patient with congenital aqueductal stenosis. The right lateral ventricle is collapsed, while the 3rd <img src='img/arrows/CO.png'/> and left lateral ventricles <img src='img/arrows/CC.png'/> are moderately dilated.*
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**Porencephalic Cyst**
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*Axial CECT shows a low-density outpouching from the right lateral ventricle <img src='/img/arrows/CS.png'/>. While a thin rim of cortex seems intact, the cyst nearly reaches brain surface and can be considered a porencephalic dilation or porencephalic lateral ventricle cyst.*
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*Axial CECT shows a low-density outpouching from the right lateral ventricle <img src='img/arrows/CS.png'/>. While a thin rim of cortex seems intact, the cyst nearly reaches brain surface and can be considered a porencephalic dilation or porencephalic lateral ventricle cyst.*
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**Metastases, Intracranial, Other**
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*Axial T2 MR shows near-complete coating of the ependymal lining of both lateral ventricles with tumor nodules <img src='/img/arrows/CS.png'/> due to metastatic seeding of an anaplastic oligodendroglioma.*
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*Axial T2 MR shows near-complete coating of the ependymal lining of both lateral ventricles with tumor nodules <img src='img/arrows/CS.png'/> due to metastatic seeding of an anaplastic oligodendroglioma.*
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**CMV, Congenital**
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*Axial NECT shows periventricular calcification <img src='/img/arrows/CS.png'/>, particularly along the caudostriatal groove, in the context of microcephaly and developmental delay. This strongly suggests congenital CMV infection. Note smooth ventricular margins, unlike calcified nodules in tuberous sclerosis complex.*
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*Axial NECT shows periventricular calcification <img src='img/arrows/CS.png'/>, particularly along the caudostriatal groove, in the context of microcephaly and developmental delay. This strongly suggests congenital CMV infection. Note smooth ventricular margins, unlike calcified nodules in tuberous sclerosis complex.*
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**Hemimegalencephaly**
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*Axial T2 MR shows enlargement of left cerebral hemisphere accompanied by an irregular ipsilateral ventricle <img src='/img/arrows/CS.png'/>. The body of the left hemispheric WM is bulky. Note left fornix <img src='/img/arrows/CC.png'/> overgrowth.*
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*Axial T2 MR shows enlargement of left cerebral hemisphere accompanied by an irregular ipsilateral ventricle <img src='img/arrows/CS.png'/>. The body of the left hemispheric WM is bulky. Note left fornix <img src='img/arrows/CC.png'/> overgrowth.*
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**Holoprosencephaly**
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*Axial T1 MR shows a large, horseshoe-shaped monoventricle <img src='/img/arrows/CC.png'/> with fused basal ganglia <img src='/img/arrows/CS.png'/>. There is no interhemispheric fissure and no identifiable lobulation or formation of ventricular horns in this alobar holoprosencephaly.*
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*Axial T1 MR shows a large, horseshoe-shaped monoventricle <img src='img/arrows/CC.png'/> with fused basal ganglia <img src='img/arrows/CS.png'/>. There is no interhemispheric fissure and no identifiable lobulation or formation of ventricular horns in this alobar holoprosencephaly.*
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