Presentation
Unsteady and forgetful.
Patient Data
The ventricular system is disproportionately enlarged. No obstruction to CSF flow out of the ventricles is evident.
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The ventricles are enlarged and a very pronounced flow void is present in the aqueduct. CSF flow studies (not shown) demonstrate elevated stroke volume (>150microL). The corpus callosum is elevated and thinned with fenestration of the septum pellucidum. The callosal angle is not increased however, nor are the sylvian fissures widened.
Case Discussion
The patient went on to have surgery. Although in this clinical context normal pressure hydrocephalus is likely (definitely a communicating hydrocephalus) the lack of reduced callosal angle and lack of widening of sylvian fissures is a little atypical. The patient was nonetheless shunted and improved clinically.
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