Presentation
Fifty days old infant, prematurely born at thirty one weeks and one day, with 1.33 kilograms birth weight.
Patient Data
Moderate symmetrical fluid dilatation of the lateral ventricles overlying the bilateral choroid plexi is noted. The 3rd and 4th ventrices grossly looks normal. No midline shift of the intra-cranial structures or obvious space occupying lesion. The brain parenchyma, sulci and the gyri are normal. No intra-cranial hemorrhage or sub-dural effusion. Corpus callosum, cavum septum pellucidum, falx cerebri, cerebellum, posterior fossa, vermis, thalami and peri-callosal vasculature plus vein of Galen are uneventful.
Trans-cranial spectral Doppler evaluation of the circle of Willis shows elevated resistive indices within the right and left middle cerebral arteries (Rt = 0.95; Lt = 0.95) with absent end diastolic flows bilaterally.
Case Discussion
Sonographic features of symmetrical biventriculomegaly with a sonographic Evan's index of 0.45 computed by measuring the lateral edges from one ventricle to the other (3.54 cm) and referenced/divided by the bi-parietal diameter (7.89 cm) of the head at the same level.
Noteworthy is that most present, reviewed literature cut off values for the index is 0.301,2. The Evan's index (EI) in this case is already greater than 0.30 thus pointing towards mild, non-communicating hydrocephalus in the setting of the relatively normal 3rd and 4th ventricles.
Elevated resistive indices with absent end diastolic flows within the bilateral middle cerebral arteries seen is likely due to raised intra-cranial pressure changes.
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