Presentation
Headache. Known obstructive hydrocephalus on treatment for one year.
Patient Data
Moderate to marked dilatation of the supratentorial ventricular system, with morbidly dilated fourth ventricle. No periventricular CSF permeation. The mamillopontine distance = 1.2 mm "reduced". Multiple thin septations seen at the subarachnoid spaces notably at the prepontine region and at forth ventricle outlets. Prominent foramen Luschka bilaterally.
CSF flow dynamic study with Ultra-thin 3D sagittal T2 weighted images & Phase contrast sequence revealed:
- ultra-thin 3D sagittal T2W shows dilated patent aqueduct with unidirectional flow.
- increased estimated flow volume of around 736 microlitres
- peak velocity averages 7.46 cm/sec
- suspected tiny spontaneous third ventriculostomy at the floor of the third ventricle
Case Discussion
Marked obstructive hydrocephalus due to fourth ventricular outlet obstruction by fine septations , partially compensated by small spontaneous third ventriculostomy. The condition is stationary for one year.