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Ross
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### Selected Images
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**Fetal Ventriculomegaly**
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*Transverse oblique US in an 18-week fetus shows mild enlargement of the lateral ventricles <img src='/img/arrows/CS.png'/> (11 mm). If the ventriculomegaly worsens later in pregnancy, fetal or postnatal MR imaging should be obtained.*
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*Transverse oblique US in an 18-week fetus shows mild enlargement of the lateral ventricles <img src='img/arrows/CS.png'/> (11 mm). If the ventriculomegaly worsens later in pregnancy, fetal or postnatal MR imaging should be obtained.*
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**Fetal Ventriculomegaly**
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*Transverse oblique US in an 18-week fetus shows mild enlargement of the lateral ventricles <img src='/img/arrows/CS.png'/> (11 mm). If the ventriculomegaly worsens later in pregnancy, fetal or postnatal MR imaging should be obtained.*
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*Transverse oblique US in an 18-week fetus shows mild enlargement of the lateral ventricles <img src='img/arrows/CS.png'/> (11 mm). If the ventriculomegaly worsens later in pregnancy, fetal or postnatal MR imaging should be obtained.*
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**Fetal Ventriculomegaly**
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*Axial T2 SSFSE MR in a fetus shows marked enlargement (> 15 mm) of the lateral ventricles <img src='/img/arrows/BS.png'/> & thinning of the cerebrum <img src='/img/arrows/BC.png'/>. With severe fetal ventriculomegaly (particularly in the setting of aqueductal stenosis), the septum pellucidum (& even the cerebral mantle) may become disrupted.*
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*Axial T2 SSFSE MR in a fetus shows marked enlargement (> 15 mm) of the lateral ventricles <img src='img/arrows/BS.png'/> & thinning of the cerebrum <img src='img/arrows/BC.png'/>. With severe fetal ventriculomegaly (particularly in the setting of aqueductal stenosis), the septum pellucidum (& even the cerebral mantle) may become disrupted.*
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**Benign Enlargement of Subarachnoid Spaces**
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*Coronal T2 MR in a 1-year-old with macrocephaly shows mild enlargement of the lateral <img src='/img/arrows/CS.png'/> & 3rd <img src='/img/arrows/CC.png'/> ventricles with moderate enlargement of the bifrontal subarachnoid spaces (SAS), which are traversed by normal veins <img src='/img/arrows/CO.png'/>. Mild ventriculomegaly is often seen in benign enlargement of subarachnoid spaces (BESS).*
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*Coronal T2 MR in a 1-year-old with macrocephaly shows mild enlargement of the lateral <img src='img/arrows/CS.png'/> & 3rd <img src='img/arrows/CC.png'/> ventricles with moderate enlargement of the bifrontal subarachnoid spaces (SAS), which are traversed by normal veins <img src='img/arrows/CO.png'/>. Mild ventriculomegaly is often seen in benign enlargement of subarachnoid spaces (BESS).*
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**Benign Enlargement of Subarachnoid Spaces**
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*Coronal color Doppler US in a 9-month-old with BESS shows normal vessels <img src='/img/arrows/CO.png'/> coursing through prominent fluid <img src='/img/arrows/CS.png'/>, an expected finding that helps differentiate the SAS from subdural collections.*
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*Coronal color Doppler US in a 9-month-old with BESS shows normal vessels <img src='img/arrows/CO.png'/> coursing through prominent fluid <img src='img/arrows/CS.png'/>, an expected finding that helps differentiate the SAS from subdural collections.*
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**Chiari 2 Malformation**
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*Sagittal 3D SSFP MR in a neonate with a myelomeningocele shows marked enlargement of the lateral ventricles <img src='/img/arrows/BS.png'/> & characteristic features of Chiari 2 malformation: Small posterior fossa, brainstem & cerebellar descent <img src='/img/arrows/CS.png'/>, tectal beaking <img src='/img/arrows/CC.png'/>, & scalloped clivus <img src='/img/arrows/CO.png'/>.*
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*Sagittal 3D SSFP MR in a neonate with a myelomeningocele shows marked enlargement of the lateral ventricles <img src='img/arrows/BS.png'/> & characteristic features of Chiari 2 malformation: Small posterior fossa, brainstem & cerebellar descent <img src='img/arrows/CS.png'/>, tectal beaking <img src='img/arrows/CC.png'/>, & scalloped clivus <img src='img/arrows/CO.png'/>.*
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**Aqueductal Stenosis**
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*Sagittal T2 MR in a neonate shows massive enlargement of the lateral ventricles <img src='/img/arrows/BS.png'/> due to obstruction at the level of the cerebral aqueduct <img src='/img/arrows/CS.png'/>. The 3rd ventricle is also enlarged <img src='/img/arrows/CO.png'/>, but the 4th ventricle is normal, typical of this disorder.*
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*Sagittal T2 MR in a neonate shows massive enlargement of the lateral ventricles <img src='img/arrows/BS.png'/> due to obstruction at the level of the cerebral aqueduct <img src='img/arrows/CS.png'/>. The 3rd ventricle is also enlarged <img src='img/arrows/CO.png'/>, but the 4th ventricle is normal, typical of this disorder.*
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**Posthemorrhagic Hydrocephalus**
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*Sagittal T2 MR in a 1-month-old former premature infant with posthemorrhagic hydrocephalus shows marked enlargement of the lateral <img src='/img/arrows/BS.png'/>, 3rd <img src='/img/arrows/BO.png'/>, & 4th <img src='/img/arrows/BC.png'/> ventricles. Note the dark hemosiderin lining the pial surface of the brainstem <img src='/img/arrows/CS.png'/> from prior intraventricular hemorrhage (IVH).*
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*Sagittal T2 MR in a 1-month-old former premature infant with posthemorrhagic hydrocephalus shows marked enlargement of the lateral <img src='img/arrows/BS.png'/>, 3rd <img src='img/arrows/BO.png'/>, & 4th <img src='img/arrows/BC.png'/> ventricles. Note the dark hemosiderin lining the pial surface of the brainstem <img src='img/arrows/CS.png'/> from prior intraventricular hemorrhage (IVH).*
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**Posthemorrhagic Hydrocephalus**
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*Axial SWI MR in a 3-month-old former premature infant with posthemorrhagic hydrocephalus shows signal loss along the ependymal margins <img src='/img/arrows/CS.png'/> of the ventricles & choroid plexus <img src='/img/arrows/CO.png'/>, consistent with prior IVH.*
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*Axial SWI MR in a 3-month-old former premature infant with posthemorrhagic hydrocephalus shows signal loss along the ependymal margins <img src='img/arrows/CS.png'/> of the ventricles & choroid plexus <img src='img/arrows/CO.png'/>, consistent with prior IVH.*
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**Acute Infectious Hydrocephalus**
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*Axial T1 C+ MR in a 7-year-old with Haemophilus influenzae meningitis shows marked expansion of the bifrontal SAS <img src='/img/arrows/CS.png'/> & mild enlargement of the lateral ventricles <img src='/img/arrows/CO.png'/>.*
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*Axial T1 C+ MR in a 7-year-old with Haemophilus influenzae meningitis shows marked expansion of the bifrontal SAS <img src='img/arrows/CS.png'/> & mild enlargement of the lateral ventricles <img src='img/arrows/CO.png'/>.*
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**Postinfectious Hydrocephalus**
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*Axial T1 C+ FS MR in an 8-month-old with tuberculous meningitis shows extensive basilar leptomeningeal enhancement <img src='/img/arrows/CS.png'/> & enlargement of the lateral ventricles <img src='/img/arrows/CO.png'/>, resulting in macrocephaly. Granulomatous infections are more likely to result in hydrocephalus compared to other bacterial meningitis.*
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*Axial T1 C+ FS MR in an 8-month-old with tuberculous meningitis shows extensive basilar leptomeningeal enhancement <img src='img/arrows/CS.png'/> & enlargement of the lateral ventricles <img src='img/arrows/CO.png'/>, resulting in macrocephaly. Granulomatous infections are more likely to result in hydrocephalus compared to other bacterial meningitis.*
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**Obstructing Tumor**
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*Sagittal FLAIR MR in a neonate with a large, obstructing, hemorrhagic posterior fossa mass <img src='/img/arrows/CO.png'/> shows enlargement of the lateral ventricles <img src='/img/arrows/CS.png'/> & posterior fossa. Note the ↑ craniofacial ratio.*
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*Sagittal FLAIR MR in a neonate with a large, obstructing, hemorrhagic posterior fossa mass <img src='img/arrows/CO.png'/> shows enlargement of the lateral ventricles <img src='img/arrows/CS.png'/> & posterior fossa. Note the ↑ craniofacial ratio.*
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**CSF Overproduction (Choroid Plexus Tumor)**
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*Coronal T1 C+ MR in a 1-year-old with a choroid plexus papilloma shows an enhancing mass <img src='/img/arrows/CS.png'/> in the right choroid plexus. The lateral ventricles are enlarged without evidence of obstruction. Hydrocephalus in this case is due to overproduction of CSF by the tumor.*
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*Coronal T1 C+ MR in a 1-year-old with a choroid plexus papilloma shows an enhancing mass <img src='img/arrows/CS.png'/> in the right choroid plexus. The lateral ventricles are enlarged without evidence of obstruction. Hydrocephalus in this case is due to overproduction of CSF by the tumor.*
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**Hypoxic-Ischemic Injury**
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*Axial FLAIR MR in a 4-year-old with a history of perinatal hypoxic-ischemic injury (HII) shows extensive areas of cortical encephalomalacia <img src='/img/arrows/CS.png'/>. Note the localized areas of ventriculomegaly <img src='/img/arrows/CO.png'/> due to overlying brain volume loss.*
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*Axial FLAIR MR in a 4-year-old with a history of perinatal hypoxic-ischemic injury (HII) shows extensive areas of cortical encephalomalacia <img src='img/arrows/CS.png'/>. Note the localized areas of ventriculomegaly <img src='img/arrows/CO.png'/> due to overlying brain volume loss.*
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**Hypoxic-Ischemic Injury**
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*Axial T2 MR in a 2-year-old with a history of perinatal HII shows symmetric areas of signal abnormality & volume loss involving the thalami <img src='/img/arrows/CS.png'/>, putamina <img src='/img/arrows/CO.png'/>, & periventricular white matter <img src='/img/arrows/CC.png'/>, resulting in enlargement of the lateral <img src='/img/arrows/BO.png'/> & 3rd <img src='/img/arrows/BS.png'/> ventricles.*
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*Axial T2 MR in a 2-year-old with a history of perinatal HII shows symmetric areas of signal abnormality & volume loss involving the thalami <img src='img/arrows/CS.png'/>, putamina <img src='img/arrows/CO.png'/>, & periventricular white matter <img src='img/arrows/CC.png'/>, resulting in enlargement of the lateral <img src='img/arrows/BO.png'/> & 3rd <img src='img/arrows/BS.png'/> ventricles.*
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**Arterial Ischemic Stroke**
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*Axial T2 MR in a 9-month-old with previous infarction shows extensive cystic encephalomalacia <img src='/img/arrows/CO.png'/> in right middle cerebral artery (MCA) territory with resultant asymmetric enlargement of the right lateral ventricle <img src='/img/arrows/CS.png'/>.*
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*Axial T2 MR in a 9-month-old with previous infarction shows extensive cystic encephalomalacia <img src='img/arrows/CO.png'/> in right middle cerebral artery (MCA) territory with resultant asymmetric enlargement of the right lateral ventricle <img src='img/arrows/CS.png'/>.*
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**Periventricular Leukomalacia**
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*Axial FLAIR MR in a 7-year-old with a history of extreme prematurity & periventricular leukomalacia (PVL) shows symmetric focal enlargement of the atria <img src='/img/arrows/CO.png'/> with adjacent white matter volume loss. The relative lack of abnormal FLAIR signal compared to the degree of volume loss is typical of PVL.*
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*Axial FLAIR MR in a 7-year-old with a history of extreme prematurity & periventricular leukomalacia (PVL) shows symmetric focal enlargement of the atria <img src='img/arrows/CO.png'/> with adjacent white matter volume loss. The relative lack of abnormal FLAIR signal compared to the degree of volume loss is typical of PVL.*
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**Porencephaly**
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*Coronal US at 2 days of life in an extremely premature (23-week) infant shows a large right germinal matrix hemorrhage <img src='/img/arrows/CS.png'/> with associated hemorrhagic venous infarction <img src='/img/arrows/CO.png'/> in the right frontoparietal white matter.*
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*Coronal US at 2 days of life in an extremely premature (23-week) infant shows a large right germinal matrix hemorrhage <img src='img/arrows/CS.png'/> with associated hemorrhagic venous infarction <img src='img/arrows/CO.png'/> in the right frontoparietal white matter.*
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**Porencephaly**
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*Coronal T2 MR in the same patient 3 months later shows the expected development of right parietal porencephaly & focal ventricular enlargement. Note the rim of T2 hypointensity <img src='/img/arrows/CS.png'/>, related to hemosiderin, which will eventually resolve.*
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*Coronal T2 MR in the same patient 3 months later shows the expected development of right parietal porencephaly & focal ventricular enlargement. Note the rim of T2 hypointensity <img src='img/arrows/CS.png'/>, related to hemosiderin, which will eventually resolve.*
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**Metabolic Brain Disease**
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*Axial T2 MR in a teenager with metachromatic leukodystrophy shows ↑ signal & volume loss in the periventricular & deep white matter <img src='/img/arrows/CS.png'/> with sparing of the subcortical white matter, characteristic of this disease. Note the enlargement of the lateral ventricles <img src='/img/arrows/CO.png'/> & sulci <img src='/img/arrows/CC.png'/> due to the brain volume loss.*
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*Axial T2 MR in a teenager with metachromatic leukodystrophy shows ↑ signal & volume loss in the periventricular & deep white matter <img src='img/arrows/CS.png'/> with sparing of the subcortical white matter, characteristic of this disease. Note the enlargement of the lateral ventricles <img src='img/arrows/CO.png'/> & sulci <img src='img/arrows/CC.png'/> due to the brain volume loss.*
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**Metabolic Brain Disease**
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*Axial T2 MR in a teenager with vanishing white matter disease shows extensive ↑ signal intensity & volume loss in the white matter <img src='/img/arrows/CS.png'/> with associated enlargement of the lateral <img src='/img/arrows/BS.png'/> & 3rd <img src='/img/arrows/BO.png'/> ventricles & sulci <img src='/img/arrows/CO.png'/>.*
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*Axial T2 MR in a teenager with vanishing white matter disease shows extensive ↑ signal intensity & volume loss in the white matter <img src='img/arrows/CS.png'/> with associated enlargement of the lateral <img src='img/arrows/BS.png'/> & 3rd <img src='img/arrows/BO.png'/> ventricles & sulci <img src='img/arrows/CO.png'/>.*
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**Hemimegalencephaly**
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*Axial T1 MR in a neonate with seizures & hemimegalencephaly shows ↑ size of the left parietooccipital hemisphere with loss of normal sulcation <img src='/img/arrows/CS.png'/> & markedly abnormal neuronal organization <img src='/img/arrows/CO.png'/>. Also note enlargement of the ipsilateral occipital horn <img src='/img/arrows/CC.png'/>.*
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*Axial T1 MR in a neonate with seizures & hemimegalencephaly shows ↑ size of the left parietooccipital hemisphere with loss of normal sulcation <img src='img/arrows/CS.png'/> & markedly abnormal neuronal organization <img src='img/arrows/CO.png'/>. Also note enlargement of the ipsilateral occipital horn <img src='img/arrows/CC.png'/>.*
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**Hemimegalencephaly**
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*Axial T1 MR in a 3-day-old with left hemimegalencephaly shows marked occipital horn enlargement <img src='/img/arrows/CO.png'/>. Note the abnormal white matter <img src='/img/arrows/CS.png'/> in the left frontal lobe. Enlargement of the ipsilateral occipital horn is common in this disease.*
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*Axial T1 MR in a 3-day-old with left hemimegalencephaly shows marked occipital horn enlargement <img src='img/arrows/CO.png'/>. Note the abnormal white matter <img src='img/arrows/CS.png'/> in the left frontal lobe. Enlargement of the ipsilateral occipital horn is common in this disease.*
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**Vein of Galen Aneurysmal Malformation**
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*Coronal T2 MR in a neonate with VGAM shows a markedly enlarged central vein <img src='/img/arrows/CO.png'/> with numerous enlarged choroidal <img src='/img/arrows/CC.png'/> & pericallosal <img src='/img/arrows/CS.png'/> feeding arteries. Note the enlarged ventricles <img src='/img/arrows/BS.png'/>, which are likely due to ↓ resorption of CSF due to ↑ venous pressures.*
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*Coronal T2 MR in a neonate with VGAM shows a markedly enlarged central vein <img src='img/arrows/CO.png'/> with numerous enlarged choroidal <img src='img/arrows/CC.png'/> & pericallosal <img src='img/arrows/CS.png'/> feeding arteries. Note the enlarged ventricles <img src='img/arrows/BS.png'/>, which are likely due to ↓ resorption of CSF due to ↑ venous pressures.*
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**Dandy-Walker Malformation**
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*Sagittal 3D SSFP MR in a 2-month-old with Dandy-Walker malformation shows a small cerebellar vermis <img src='/img/arrows/CO.png'/> & large posterior fossa cyst <img src='/img/arrows/CS.png'/> that is continuous with the 4th ventricle. There is elevation of the tentorium & torcular Herophili <img src='/img/arrows/CC.png'/>.*
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*Sagittal 3D SSFP MR in a 2-month-old with Dandy-Walker malformation shows a small cerebellar vermis <img src='img/arrows/CO.png'/> & large posterior fossa cyst <img src='img/arrows/CS.png'/> that is continuous with the 4th ventricle. There is elevation of the tentorium & torcular Herophili <img src='img/arrows/CC.png'/>.*
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**Hydranencephaly**
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*Axial NECT in a 4-year-old with hydranencephaly shows porencephaly in the bilateral MCA <img src='/img/arrows/CO.png'/> & left anterior cerebral artery (ACA) <img src='/img/arrows/CS.png'/> territories in continuity with the lateral ventricles. Note the intact falx <img src='/img/arrows/CC.png'/>. Patients with hydranencephaly typically become macrocephalic due to poor CSF regulation.*
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*Axial NECT in a 4-year-old with hydranencephaly shows porencephaly in the bilateral MCA <img src='img/arrows/CO.png'/> & left anterior cerebral artery (ACA) <img src='img/arrows/CS.png'/> territories in continuity with the lateral ventricles. Note the intact falx <img src='img/arrows/CC.png'/>. Patients with hydranencephaly typically become macrocephalic due to poor CSF regulation.*
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**Holoprosencephaly**
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*Sagittal T2 MR in a neonate with holoprosencephaly shows an enlarged monoventricle <img src='/img/arrows/CS.png'/>. However, the patient is microcephalic overall due to the ↓ brain parenchymal volume.*
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*Sagittal T2 MR in a neonate with holoprosencephaly shows an enlarged monoventricle <img src='img/arrows/CS.png'/>. However, the patient is microcephalic overall due to the ↓ brain parenchymal volume.*
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