Large head circumference. A brain CT was performed (not shown), and VP shunt was inserted.
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MRI sequences demonstrate
- enlarged posterior fossa with a trocular lying above the level of the lambdoid (torcular-lambdoid inversion) due to an abnormally high tentorium
- hypoplasia of the vermis with a small vermian remnant displaced and rotated superiorly
- cystic dilatation of the 4th ventricle extending posteriorly forming a cystic space with anterolateral displacement of the cerebellar hemispheres.
- the sagittal Fiesta sequence shows narrowing of the aqueduct of Sylvius with dilated 3rd and lateral ventricles.
The tip of the right VP shunt is well-visualized in projection of the right lateral ventricle.