Tectal glioma with acute obstructive hydrocephalus
Unilateral abducent nerve palsy with diplopia and headache to rule out neurological cause.
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There is a well defined high T2 and FLAIR signal intensity lesion seen at the tectal plate of the midbrain causing mass effect on the superior part of the aqueduct of sylvius resulting in obstructive hydrocephalus involving both lateral and third ventricles with CSF seepage.
This adolescent patient is previously healthy, the MRI findings of acute obstructive hydrocephalus and is caused by this small tectal mass.