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title: "Intraventricular Obstructive Hydrocephalus"
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docid: "eeac8d9b-1fdc-432e-8e09-11589611f7a8"
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authors:
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- key: "a25c450b-3d34-4f64-bba3-cc0834813df6"
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value: "Miral D. Jhaveri, MD, MBA"
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breadcrumbs:
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-
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name: "Brain"
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slug: "brain"
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treeNodeId: "6d8829f1-14d7-45af-8675-255189aa526a"
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-
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name: "Diagnosis"
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slug: "diagnosis"
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treeNodeId: "51c00394-446e-4a38-94af-d3b1d14d34e8"
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-
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name: "Anatomy-Based Diagnoses"
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slug: "anatomy-based-diagnoses"
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treeNodeId: "529d3e33-f508-498c-bc70-cf962e81e629"
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-
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name: "Ventricles and Cisterns"
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slug: "ventricles-and-cisterns"
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treeNodeId: "33b267f0-908c-4c77-81f8-f6135d1bc592"
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-
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name: "Hydrocephalus"
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slug: "hydrocephalus"
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treeNodeId: "9ce86e3b-fab6-4657-9e51-5f47bb1a51b5"
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-
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name: "Intraventricular Obstructive Hydrocephalus"
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slug: "intraventricular-obstructive-hydro-"
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treeNodeId: null
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category: "Brain"
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cmeTopicId: "7f17d5cc-6470-403d-8f99-cbb3d3ea610d"
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documentVersionId: "102c8265-55ef-4963-964e-d8ed6d766992"
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imageCount: 30
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lastUpdated: "09/24/20"
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pageDescription: "Intraventricular Obstructive Hydrocephalus"
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pageKeywords: "Brain, Diagnosis, Anatomy-Based Diagnoses, Ventricles and Cisterns, Hydrocephalus, Intraventricular Obstructive Hydrocephalus"
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pageTitle: "Intraventricular Obstructive Hydrocephalus | STATdx"
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enhancedTitle: "Intraventricular Obstructive Hydrocephalus"
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type: "DX"
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references: true
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breadcrumbs:
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- "Brain"
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- "Diagnosis"
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- "Anatomy-Based Diagnoses"
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- "Ventricles and Cisterns"
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- "Hydrocephalus"
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- "Intraventricular Obstructive Hydrocephalus"
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---
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# KEY FACTS
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- ## Terminology
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- Intraventricular obstructive hydrocephalus (IVOH) = obstruction proximal to foramina of Luschka, Magendie
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- Acute IVOH (aIVOH)
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- Chronic compensated IVOH (cIVOH)
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- ## Imaging
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- aIVOH = ballooned ventricles plus indistinct (blurred) margins
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- "Fingers" of CSF extend into periventricular WM
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- Most striking around ventricular horns (periventricular halos)
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- After decompression, corpus callosum may show hyperintensity
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- cIVOH = ballooned ventricles without periventricular halo
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- ## Top Differential Diagnoses
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- Ventricular enlargement secondary to parenchymal loss
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- Normal-pressure hydrocephalus
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- Extraventricular obstructive hydrocephalus
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- Choroid plexus papilloma
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- ## Pathology
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- Intraventricular obstruction to CSF flow
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- CSF production continues, ventricular pressure ↑
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- Ventricles expand, compress adjacent parenchyma
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- Periventricular interstitial fluid ↑
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- Leads to myelin vacuolization, destruction
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- Pathology varies depending on obstruction etiology
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- ## Clinical Issues
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- Varies with acuity, severity
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- Headache, papilledema (aIVOH)
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- Nausea, vomiting, diplopia (6th nerve palsy)
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- ## Diagnostic Checklist
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- Size of ventricles generally correlates poorly with intracranial pressure
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# TERMINOLOGY
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- ## Abbreviations
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- Intraventricular obstructive hydrocephalus (IVOH)
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- Acute IVOH (aIVOH)
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- Chronic compensated IVOH (cIVOH)
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- ## Synonyms
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- Noncommunicating hydrocephalus
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- ## Definitions
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- Enlarged ventricles caused by physical obstruction at or proximal to 4th ventricular outflow foramina (of Luschka, Magendie)
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# IMAGING
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- ## General Features
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- ### Best diagnostic clue
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- aIVOH
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- Ballooned ventricles with indistinct (blurred) margins
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- cIVOH
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- Ballooned ventricles without periventricular halo
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- ### Size
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- Bifrontal horn:intracranial diameter ratio > 0.3
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- Temporal horn width > 3 mm
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- ### Morphology
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- Varies with site, duration of blockage
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- Global/focally enlarged ventricle(s) ± ↑ intracranial pressure (ICP)
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- Ventricles proximal to obstruction enlarge, appear more rounded
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- Look for enlarged anterior recesses of 3rd ventricle
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- ## CT Findings
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- ### NECT
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- Large ventricles proximal to obstruction
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- aIVOH
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- Ballooned ventricles with periventricular low-density halo
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- cIVOH
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- Ballooned ventricles without thick periventricular halo
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- Basal cisterns, sulci compressed/obliterated
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- ## MR Findings
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- ### T1WI
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- Lateral ventricles enlarged
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- Corpus callosum (CC) thinned, stretched upward
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- May be impinged against falx
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- Impaction may cause pressure necrosis
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- Fornix, internal cerebral veins (ICV) displaced downward
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- Enlarged 3rd ventricle often herniated into expanded sella
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- Funnel-shaped aqueduct of Sylvius in aqueductal stenosis
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- ### T2WI
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- aIVOH
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- "Fingers" of CSF-like hyperintensity extend into periventricular white matter (WM), most striking around ventricular horns (periventricular halos)
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- Disturbed/turbulent CSF flow
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- Absent aqueductal flow void common
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- CC may appear hyperintense
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- cIVOH
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- Large ventricles, normal CSF pressure
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- No periventricular halo
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- CC may show hyperintensity after decompression (15% of shunted IVOH cases)
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- Thin-section T2WI, FIESTA, or CISS sequences
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- Exquisitely delineate CSF spaces
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- May demonstrate subtle abnormalities not detected on standard images
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- ### FLAIR
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- Fluid in periventricular halo does not suppress
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- ### T1WI C+
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- Neoplasm causing IVOH may enhance
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- aIVOH may cause leptomeningeal vascular stasis, enhancement
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- Can mimic meningitis, metastases
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- ### MRS
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- Small lactate resonances can be detected in up to 20% of CSF spaces, even if no hydrocephalus
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- ## Other Modality Findings
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- Contrast-enhanced ventriculography
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- MR/CT used to identify site of obstruction, status of 3rd ventriculostomies
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- MR can be used for assessing CSF flow
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- Cardiac gated-phase contrast MR
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- May show absent aqueductal CSF flow
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- ## Imaging Recommendations
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- ### Best imaging tool
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- MR with contrast to evaluate cause of CSF obstruction
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- ### Protocol advice
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- 3D FEISTA/CISS
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- ↓ CSF flow artifact
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- Allows better delineation of ventricular contour, septa
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- Sagittal high-resolution T2-weighted images
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# DIFFERENTIAL DIAGNOSIS
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- ## Ventricular Enlargement Secondary to Parenchymal Loss
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- Old term: Ex vacuo hydrocephalus (not used)
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- Age related (ventricular volume ↑ 1.2-1.4 mL after 60 years)
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- Ischemia/infarction, trauma, infection, toxic
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- Obtuse frontal angle (> 110°)
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- Diffuse/focal enlargement of sulci, cisterns
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- Normal lateral ventricles can be asymmetric (related to handedness, not sex)
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- May correlate with some psychiatric disorders (e.g., schizophrenia)
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- [Normal-Pressure Hydrocephalus](/document/normal-pressure-hydrocephalus/ba3f857d-58de-4f21-8463-1631b4cb9972)
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- Progressive dementia, gait disturbance, incontinence
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- Ventricular dilation with normal CSF pressure
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- Sulci normal/minimally enlarged
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- ↑ CSF displacement through aqueduct
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- MRS shows lactate peak
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- [Extraventricular Obstructive Hydrocephalus](/document/extraventricular-obstructive-hydro-/a0886d4c-f504-4165-bb52-2400e2385f68)
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- Dilated ventricles due to mismatch between CSF formation, absorption
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- ↓ CSF absorption through arachnoid villi
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- Subarachnoid hemorrhage most common cause
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- Others: Meningitis, carcinomatosis, granulomatous disease
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- [Choroid Plexus Papilloma](/document/choroid-plexus-papilloma/18e712f5-8553-487d-a939-044336cbf0ad)
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- Accounts for 2-5% of childhood intracranial tumors
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- Child < 5 years with ↑ ICP
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- Most common lateral ventricle trigone
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- May overproduce CSF
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- Hemorrhage, tumor spread may cause IVOH
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- ## Longstanding Overt Ventriculomegaly in Adults
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- Early childhood onset or longstanding progression of hydrocephalus into adulthood
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- Markedly enlarged ventricles, high ICP
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- ## Benign Enlargement of Subarachnoid Spaces and Ventricles
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- Seen in association with macrocephaly in infants
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- Not associated with developmental delay
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# PATHOLOGY
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- ## General Features
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- ### Etiology
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- Normal CSF production = ~ 0.4 mL/min, 500-600 mL/24 hrs
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- Total volume of CSF in adult = 125-150 mL
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- Intraventricular obstruction to CSF flow; as CSF production continues, ventricular fluid pressure ↑
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- Ventricles expand, compress adjacent parenchyma; stretching may rupture/open ependymal cell junctions
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- Periventricular interstitial fluid ↑ → myelin destruction
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- Etiology depends on site
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- Foramen of Monro
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- Colloid cyst
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- Subependymal nodule, tuberous sclerosis complex
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- Subependymal giant cell astrocytoma
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- 3rd ventricle
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- Pituitary macroadenoma
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- Craniopharyngioma
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- Aqueduct of Sylvius
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- Aqueductal stenosis
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- Tectal glioma
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- Pineal region tumors
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- 4th ventricle
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- Medulloblastoma, ependymoma
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- Glioma, pilocytic astrocytoma, hemangioblastoma
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- Cerebellar infarct
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- Congenital anomalies (Chiari malformations, Dandy-Walker malformations, rhombencephalosynapsis)
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- Metastasis, neurocysticercosis, or meningioma can occur at multiple intraventricular locations
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- ### Genetics
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- Cell adhesion molecule L1 (*L1CAM*) only gene recognized to cause congenital hydrocephalus
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- Located on X chromosome (Xq28)
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- Complications of hydrocephalus
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- CC impingement syndrome
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- Medial atrial diverticula
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- ## Gross Pathologic & Surgical Features
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- Focal/generalized ventricular enlargement
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- Ependyma, adjacent WM are secondarily injured
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- Variable pathology depending on causative factor
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- ## Microscopic Features
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- ↑ periventricular extracellular space
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- Ependymal lining damaged or lost; surrounding WM becomes pale and rarefied
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# CLINICAL ISSUES
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- ## Presentation
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- ### Most common signs/symptoms
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- Varies with acuity, severity
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- Headache, papilledema (aIVOH)
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- Nausea, vomiting, diplopia (6th nerve palsy)
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- ### Clinical profile
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- Varies with etiology, severity, age of onset
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- ## Demographics
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- ### Age
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- May be any age from in utero (congenital hydrocephalus) to adult
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- ### Epidemiology
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- Epidemiologic data varies widely, depending upon etiology and type of hydrocephalus
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- ## Natural History & Prognosis
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- Usually progressive unless treated
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- ## Treatment
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- Medical management to delay surgical intervention
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- CSF diversion (shunt), endoscopic intervention, and ventriculostomy
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- Surgery to alleviate primary cause of obstruction
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- Most common neurosurgical procedure in children = CSF shunting for hydrocephalus
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# DIAGNOSTIC CHECKLIST
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- ## Consider
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- Longstanding aqueductal stenosis can be caused by slow-growing tectal tumor
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- Rarely, hydrocephalus caused by spinal tumor
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- ## Image Interpretation Pearls
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- Size of ventricles generally correlates poorly with ICP
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- Pulsatile CSF may create confusing signal intensity, even mimic intraventricular mass
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- Ventricular asymmetry can be normal variant
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- If seen with absent septum pellucidum in fetus/neonate, look for vermis (r/o rhombencephalosynapsis)
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5b1dd5dd-62fc-4446-8e5d-a43b8e65444e
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## References
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# Selected References
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1. [Gholampour S et al: Comparing the efficiency of two treatment methods of hydrocephalus: shunt implantation and endoscopic third ventriculostomy. Basic Clin Neurosci. 10(3):185-98, 2019](http://www.ncbi.nlm.nih.gov/pubmed/?term=31462974%5Bpmid%5D)
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1. [Santiago-Dieppa DR et al: Obstructive hydrocephalus. N Engl J Med. 381(5):e10, 2019](http://www.ncbi.nlm.nih.gov/pubmed/?term=31365804%5Bpmid%5D)
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1. [Chellathurai A et al: Role of 3D SPACE sequence and susceptibility weighted imaging in the evaluation of hydrocephalus and treatment-oriented refined classification of hydrocephalus. Indian J Radiol Imaging. 28(4):385-94, 2018](http://www.ncbi.nlm.nih.gov/pubmed/?term=30662197%5Bpmid%5D)
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1. [Hurni Y et al: Arrested hydrocephalus in childhood: case series and review of the literature. Neuropediatrics. 49(5):302-9, 2018](http://www.ncbi.nlm.nih.gov/pubmed/?term=29933461%5Bpmid%5D)
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1. [Langner S et al: Diagnosis and differential diagnosis of hydrocephalus in adults. Rofo. 189(8):728-39, 2017](http://www.ncbi.nlm.nih.gov/pubmed/?term=28511266%5Bpmid%5D)
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1. [Leinonen V et al: Cerebrospinal fluid circulation and hydrocephalus. Handb Clin Neurol. 145:39-50, 2017](http://www.ncbi.nlm.nih.gov/pubmed/?term=28987185%5Bpmid%5D)
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1. [Algin O et al: Assessment of third ventriculostomy patency with the 3D-SPACE technique: a preliminary multicenter research study. J Neurosurg. 122(6):1347-55, 2015](http://www.ncbi.nlm.nih.gov/pubmed/?term=25859808%5Bpmid%5D)
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1. [Russo N et al: Endoscopic approaches to intraventricular lesions. J Neurol Surg A Cent Eur Neurosurg. 76(5):353-60, 2015](http://www.ncbi.nlm.nih.gov/pubmed/?term=26008954%5Bpmid%5D)
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1. [Flannery AM et al: Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 1: Introduction and methodology. J Neurosurg Pediatr. 14 Suppl 1:3-7, 2014](http://www.ncbi.nlm.nih.gov/pubmed/?term=25988777%5Bpmid%5D)
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1. [Dinçer A et al: Radiologic evaluation of pediatric hydrocephalus. Childs Nerv Syst. 27(10):1543-62, 2011](http://www.ncbi.nlm.nih.gov/pubmed/?term=21928020%5Bpmid%5D)
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1. [Mirone G et al: Hydrocephalus and spinal cord tumors: a review. Childs Nerv Syst. 27(10):1741-9, 2011](http://www.ncbi.nlm.nih.gov/pubmed/?term=21928038%5Bpmid%5D)
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1. [Oi S: Classification of hydrocephalus: critical analysis of classification categories and advantages of "multi-categorical hydrocephalus classification" (Mc HC). Childs Nerv Syst. 27(10):1523-33, 2011](http://www.ncbi.nlm.nih.gov/pubmed/?term=21928018%5Bpmid%5D)
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1. [Dinçer A et al: Is all "communicating" hydrocephalus really communicating? Prospective study on the value of 3D-constructive interference in steady state sequence at 3T. AJNR Am J Neuroradiol. 30(10):1898-906, 2009](http://www.ncbi.nlm.nih.gov/pubmed/?term=19643921%5Bpmid%5D)
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1. [Feng F et al: Evaluation of radionuclide cerebrospinal fluid scintigraphy as a guide in the management of patients with hydrocephalus. Clin Imaging. 33(2):85-9, 2009](http://www.ncbi.nlm.nih.gov/pubmed/?term=19237049%5Bpmid%5D)
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1. [Linninger AA et al: Normal and hydrocephalic brain dynamics: the role of reduced cerebrospinal fluid reabsorption in ventricular enlargement. Ann Biomed Eng. 37(7):1434-47, 2009](http://www.ncbi.nlm.nih.gov/pubmed/?term=19373558%5Bpmid%5D)
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1. [Oertel JM et al: Endoscopic third ventriculostomy in obstructive hydrocephalus due to giant basilar artery aneurysm. J Neurosurg. 110(1):14-8, 2009](http://www.ncbi.nlm.nih.gov/pubmed/?term=18991498%5Bpmid%5D)
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1. [Stoquart-El Sankari S et al: Phase-contrast MR imaging support for the diagnosis of aqueductal stenosis. AJNR Am J Neuroradiol. 30(1):209-14, 2009](http://www.ncbi.nlm.nih.gov/pubmed/?term=18832663%5Bpmid%5D)
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1. [Sekula RF Jr et al: A case of an elderly adult presenting with obstructive hydrocephalus secondary to a rare hemorrhagic suprasellar pilocytic astrocytoma. Clin Neuropathol. 27(6):396-9, 2008](http://www.ncbi.nlm.nih.gov/pubmed/?term=19130737%5Bpmid%5D)
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1. [Yamada S et al: Visualization of cerebrospinal fluid movement with spin labeling at MR imaging: preliminary results in normal and pathophysiologic conditions. Radiology. 249(2):644-52, 2008](http://www.ncbi.nlm.nih.gov/pubmed/?term=18936318%5Bpmid%5D)
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1. [Erdogan AR et al: Sex and handedness differences in size of cerebral ventricles of normal subjects. Int J Neurosci. 114(1):67-73, 2004](http://www.ncbi.nlm.nih.gov/pubmed/?term=14660068%5Bpmid%5D)
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1. [Gaser C et al: Ventricular enlargement in schizophrenia related to volume reduction of the thalamus, striatum, and superior temporal cortex. Am J Psychiatry. 161(1):154-6, 2004](http://www.ncbi.nlm.nih.gov/pubmed/?term=14702264%5Bpmid%5D)
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1. [Wyldes M et al: Isolated mild fetal ventriculomegaly. Arch Dis Child Fetal Neonatal Ed. 89(1):F9-13, 2004](http://www.ncbi.nlm.nih.gov/pubmed/?term=14711845%5Bpmid%5D)
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1. [Akhondi H et al: Hydrocephalus as a presenting manifestation of neurosarcoidosis. South Med J. 96(4):403-6, 2003](http://www.ncbi.nlm.nih.gov/pubmed/?term=12916562%5Bpmid%5D)
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1. [Bhattacharyya KB et al: Bobble-head doll syndrome: some atypical features with a new lesion and review of the literature. Acta Neurol Scand. 108(3):216-20, 2003](http://www.ncbi.nlm.nih.gov/pubmed/?term=12911467%5Bpmid%5D)
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1. Brown KP et al: 1H MRS in human hydrocephalus. J MRI. 14:291-9, 2003
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1. [Grunert P et al: The role of third ventriculostomy in the management of obstructive hydrocephalus. Minim Invasive Neurosurg. 46(1):16-21, 2003](http://www.ncbi.nlm.nih.gov/pubmed/?term=12640578%5Bpmid%5D)
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1. [Joseph VB et al: MR ventriculography for the study of CSF flow. AJNR Am J Neuroradiol. 24(3):373-81, 2003](http://www.ncbi.nlm.nih.gov/pubmed/?term=12637285%5Bpmid%5D)
|
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1. [Sener RN: Callosal changes in obstructive hydrocephalus: observations with FLAIR imaging, and diffusion MRI. Comput Med Imaging Graph. 26(5):333-7, 2002](http://www.ncbi.nlm.nih.gov/pubmed/?term=12204238%5Bpmid%5D)
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## Images
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### Selected Images
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*Axial FLAIR MR in a patient with headache and vomiting demonstrates a colloid cyst at the foramen of Monro <img src='/img/arrows/CC.png'/> causing intraventricular obstructive hydrocephalus (IVOH) with dilatation of both lateral ventricles <img src='/img/arrows/CS.png'/>. Note thin rim of periventricular hyperintensity <img src='/img/arrows/CO.png'/> due to interstitial edema.*
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*Axial FLAIR MR in a patient with headache and vomiting demonstrates a colloid cyst at the foramen of Monro <img src='/img/arrows/CC.png'/> causing intraventricular obstructive hydrocephalus (IVOH) with dilatation of both lateral ventricles <img src='/img/arrows/CS.png'/>. Note thin rim of periventricular hyperintensity <img src='/img/arrows/CO.png'/> due to interstitial edema.*
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*Axial NECT in a patient with pineal region germinoma <img src='/img/arrows/CC.png'/> shows marked dilatation of the lateral ventricles <img src='/img/arrows/CO.png'/> and anterior 3rd ventricle <img src='/img/arrows/CS.png'/> with periventricular halo <img src='/img/arrows/WC.png'/> and diffuse effacement of the cortical sulci.*
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*Coronal T1 C+ MR in a patient presenting with headache and ataxia demonstrates a large heterogeneously enhancing mass <img src='/img/arrows/CO.png'/> in the left cerebellum with mass effect and effacement of the 4th ventricle <img src='/img/arrows/CC.png'/>. Biopsy revealed a glioblastoma.*
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*Axial FLAIR MR in the same patient shows marked dilatation of the lateral ventricles <img src='/img/arrows/CC.png'/> with extensive periventricular interstitial edema <img src='/img/arrows/CS.png'/> caused by compromised drainage of interstitial fluid or transependymal CSF migration.*
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*Sagittal CISS MR in a patient with obstruction at the 4th ventricular outlet due to adhesions shows ballooning of the 4th ventricle <img src='/img/arrows/CO.png'/>, widening of the aqueduct of Sylvius <img src='/img/arrows/CC.png'/>, dilated 3rd and lateral ventricles with downward sloping of 3rd ventricular floor <img src='/img/arrows/CS.png'/>.*
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*Axial FLAIR MR in a patient with tuberous sclerosis shows large subependymal giant cell astrocytoma <img src='/img/arrows/CS.png'/> causing obstructive hydrocephalus <img src='/img/arrows/CC.png'/> with mild periventricular edema <img src='/img/arrows/CO.png'/>. Note the subtle hyperintensity in the occipital lobe tuber <img src='/img/arrows/WO.png'/>.*
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*Sagittal CISS MR in a patient with aqueductal stenosis due to a thin web <img src='/img/arrows/CC.png'/> causing obstructive hydrocephalus is shown. High resolution thin-section T2 MR exquisitely delineates the CSF spaces and may demonstrate subtle abnormalities not detected on standard sequences.*
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*Axial FLAIR MR in the same patient shows marked enlarged lateral ventricles <img src='/img/arrows/CO.png'/> with a very thin periventricular hyperintense rim <img src='/img/arrows/CC.png'/> and no sulcal effacement due to chronic compensated IVOH.*
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*Axial FLAIR MR in a patient with IVOH shows an ependymal cyst <img src='/img/arrows/CC.png'/> at the foramen of Monro with asymmetric dilatation of the lateral ventricles, L > R. There is marked bulging of the medial wall <img src='/img/arrows/CO.png'/> of the left lateral ventricle.*
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*Sagittal T1 MR in the same patient demonstrates the large medial atrial diverticula <img src='/img/arrows/CC.png'/>, which herniates inferiorly through the tentorial incisura into the posterior fossa, compressing the vermis <img src='/img/arrows/CO.png'/>, tectal plate <img src='/img/arrows/CS.png'/>, aqueduct, and 4th ventricle <img src='/img/arrows/WC.png'/>.*
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### Additional Images
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*Sagittal T1WI MR shows large mass within the 4th ventricle <img src='/img/arrows/BO.png'/> causing IVOH or noncommunicating hydrocephalus.*
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*Sagittal T2WI 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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*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 T1WI 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 IVOH 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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*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 T1WI 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 T1WI 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 T2WI 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 T2WI 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 T1WI 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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*Axial T2WI MR in a patient with corpus callosum impingement syndrome, after shunting for severe IVOH, shows a shunt tube <img src='/img/arrows/WC.png'/>, bilateral subdural fluid collections, and striated hyperintensity in the corpus callosum <img src='/img/arrows/BS.png'/> with somewhat less striking changes in the periventricular white matter <img src='/img/arrows/WO.png'/>. (Courtesy S. Candy, MD.)*
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*Axial NECT in a patient with headache demonstrates a classic colloid cyst at the foramen of Monro <img src='/img/arrows/CC.png'/> causing IVOH with dilatation of both lateral ventricles <img src='/img/arrows/CS.png'/>. Note the periventricular hypodensities <img src='/img/arrows/CO.png'/> due to transependymal leakage of CSF.*
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*Axial CECT demonstrates a subacute left posterior inferior cerebellar infarct <img src='/img/arrows/CS.png'/> causing mass effect on the 4th ventricle <img src='/img/arrows/CC.png'/> and resulting in obstructive hydrocephalus <img src='/img/arrows/CO.png'/>.*
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*Axial FLAIR MR shows massive enlargement of the 3rd and lateral ventricles by a CSF-like mass within the 3rd ventricle <img src='/img/arrows/WS.png'/>. There is periventricular interstitial edema <img src='/img/arrows/WO.png'/>. At surgery, an ependymal cyst of the 3rd ventricle was found and fenestrated.*
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*Sagittal T1 MR shows a large arachnoid cyst <img src='/img/arrows/CC.png'/> in the superior cerebellar cistern causing severe mass effect on the tectal plate <img src='/img/arrows/CS.png'/> and aqueduct <img src='/img/arrows/WC.png'/>.There is dilatation of the 3rd and lateral ventricles with thinning of the corpus callosum <img src='/img/arrows/CO.png'/>.*
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*Sagittal T1WI C+ MR shows a cyst <img src='/img/arrows/WS.png'/> with an enhancing mural nodule <img src='/img/arrows/WO.png'/> of hemangioblastoma in the vermis, causing severe effacement of the 4th ventricle <img src='/img/arrows/WC.png'/> and obstructive hydrocephalus.*
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*Sagittal T2 MR demonstrates an enlarged T2 hyperintense tectal plate glioma <img src='/img/arrows/CC.png'/>, which causes obstruction at the aqueduct and dilatation of the lateral <img src='/img/arrows/CS.png'/> and 3rd ventricles <img src='/img/arrows/CO.png'/>.*
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Reference in New Issue
Block a user