Blake's pouch cyst

Case contributed by Sepehr Haghighi
Diagnosis certain

Presentation

Headache

Patient Data

Age: 5 years
Gender: Female
mri

The dilated fourth ventricle is seen freely communicating with infracerebellar posterior fossa cyst. The cerebellar vermis is upward displaced with no hypoplasia. Preserved T2 hypointense signal void flow at aqueduct showing normal bidirectional flow. Normal bidirectional flow of CSF at the craniocervical junction and cervical subarachnoid spaces is detected.

These findings are compatible with Blake's pouch cyst.

Case Discussion

Tetraventricular moderate arrested "compensated" hydrocephalus, with hyperdynamic CSF flow across patent aqueduct and suggested persistent Blake's pouch cyst.

Blake's pouch cyst is a posterior fossa developmental cyst that represents posterior ballooning of inferior medullary velum into cisterna magna, below and posterior to the vermis. It communicates with an open 4th ventricle. 

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