Distinguishing primary hydrocephalus from atrophy resulting in compensatory enlargement of the CSF spaces as the cause of ventriculomegaly can be, at times, challenging in image interpretation.
Radiographic features
Features that favour hydrocephalus include:
dilatation of the temporal horns
lack of dilatation of parahippocampal fissures 4
increased frontal horn radius (used as part of Evans' Index)
periventricular interstitial oedema from the transependymal flow
intraventricular flow void from CSF movement on MRI
widening of the third ventricular recesses: midsagittal plane
upward displacement of corpus callosum 3: midsagittal plane
depression of the posterior fornix: midsagittal plane
decreased mamillopontine distance: midsagittal plane
narrow callosal angle
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