Presentation
Headaches.
Patient Data
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The lateral and third ventricles are markedly enlarged with evidence of transependymal edema and effacement of the cortical sulci. The aqueduct is stenosed in its middle third and no flow through it is evident on CSF flow studies. The tectal plate appears normal.
Flow does appear to extend through the third ventricular floor, although this could represent pulsation on the inferiorly displaced floor by the adjacent basilar artery.
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Enlarged third ventricle with expansion of the supraoptic recess (SOR), infundibular recess (IR) and pineal recess (PR). Basilar tip (red arrow) is closely related to the inferiorly displaced floor of the third ventricle.
On flow studies, flow induced signal can be seen passing in front of the basilar tip and into the third ventricle.
Case Discussion
The patient went on to have a third ventriculostomy which confirmed the presence of a pin-hole defect in the floor of the third ventricle, inadequate for treatment of non-communicating hydrocephalus. This was endoscopically enlarged and the patient has made an uneventful recovery.
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