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Congenital aqueductal diaphragm

Case contributed by Ahmed Abdrabou
Diagnosis certain

Presentation

Headache and blurring of vision

Patient Data

Age: 5 years
Gender: Male

Marked dilatation of the lateral and 3rd ventricles down to the aqueduct of Sylvius suggesting obstructive non communicating hydrocephalus. Normal 4th ventricular dimension.

Annotated image

The yellow arrow refers to the diaphragm at the mid aqueduct of Sylvius.

Case Discussion

Aqueductal pathology are common causes of obstructive non communicating hydrocephalus characterized by supratentorial ventricular dilatation and normal size 4th ventricle. Note the lack of transependymal spread of CSF, indicating a more insidious / chronic nature of the hydrocephalus. Aqueductal stenosis is the commonest pathology while diaphragm/web are rare. Treatment was done by endoscopy.

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