|
A 3 year-old girl presented with an enlarging head circumference in association with headaches and an altered gait. On examination, she had papilledema, impaired upgaze, and bilateral lid retraction. |
| Non-Communicating Hydrocephalus:
(Left and Middle) T1-weighted axial MRIs; (Right) T1-weighted with
gadolinium sagittal MRI. Note the massive enlargement of
the lateral ventricles. In addition, the third ventricle is markedly
enlarged and has assumed a circular shape, as opposed to the normal
slit appearance. The cause of the
hydrocephalus can be seen on the sagittal MRI scan - there is compression of the cerebral
aqueduct by an enlarged tectum of the midbrain (i.e., the
quadrigeminal plate). Subsequent biopsy demonstrated a low-grade
glioma.
Hydrocephalus is recognized as enlarged ventricles out of proportion to the amount of cerebral atrophy. Non-communicating (obstructive) hydrocephalus occurs when the ventricular system is not in continuity with the subarachnoid space. Most often, the site of the blockage in non-communicating hydrocephalus is at the cerebral aqueduct, but rarely can occur at the foramen of Monro, the third ventricle, or the outlet of the fourth ventricle. Acute non-compensated, non-communicating (obstructive) hydrocephalus is a neurosurgical emergency as the non-compensated hydrocephalus results in a progressive increase in intracranial pressure, which if left unchecked will result in herniation and brain death. It is potentially treatable by shunting. |
Revised
11/04/06
Copyrighted 2006. David C Preston