Communicating hydrocephalus (long-standing)
Known ventriculomegaly. Aqueduct stenosis?
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Prominent ventriculomegaly and cisterna magna with relative sulcal effacement. The ependymal surface is again scalloped with minor right frontal FLAIR hyperintensity noted. The aqueduct remains patent. A thin shelf is noted at the mid aqueduct level anteriorly, with mild turbulence, and aqueductal CSF flow is hyperdynamic (aqueductal stroke volume, noise corrected 400 microL). Flow is seen in the cisterna magna and around the upper cord.
Despite a minor shelf of tissue in mid aqueduct, there is no obstruction at this level and findings still favour a long-standing communicating hydrocephalus.
Although CSF quantification is difficult, identifying definite flow in an aqueduct is an excellent way of proving the absence of aqueduct obstruction.