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CB1029

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Case Notes

History

21 yo male who present with persistent headaches after minor head injury.

Exam

Prior Study

T2-w spin-echo or noncontrast T1-w MR, noncontrast CT with scout skull image
1. Evidence of chronic raised intracranial pressure related to advanced slowly progressive hydrocephalus caused by partial block of CSF egress from tectal dysplasia and from developmentally small posterior fossa compressing the 4th ventricular outlets.
2. Calvarial changes of chronic raised ICP on the scout for CT with split cranial sutures and remodeling and enlargement of the sella turcica.
3. Mulitcentric developmental dysmorphic changes including aqueductal stenosis, cortical migrational abnormalities, and hypoplasia of the clivus and posterior fossa.

Sagittal post contrast MR
1. Grade 3/4 chronic ventriculomegaly most consistent with chronic arrested hydrocephalus. 
2. Brain formation anomalies are evident with cortical dysplasia, mesencephalic/quadrigeminal plate dysplasia causing aqueductal stenosis, and chronic cerebellar tonsillar ectopia
3. Sellar remodeling related to chronic herniation of the ventral 3rd ventricle and suprasellar cistern into the expanded sella turcica.

MR flair
1. Grade 3/4 arrested hydrocephalus with evidence of chronic raised ICP, as above.

Dicom

 
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Section 1

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CB1029

Findings

Post contrast head CT or MR

There is contrast enhancement in an intraventricular mass causing hydrocephalus arising from the septum pellucidum, the ependymal surface, or the choroid plexus (choroid papilloma can cause CSF overproduction type of hydrocephalus.

There is contrast enhancement any intra or extra axial mass lesion causing hydrocephalus.

There is contrast enhancement in any intraventricular inflammatory process (as neurosarcoidosis) causing hydrocephalus.

There is ependymal surface contrast enhancement consistent with active ventriculitis, or enhancing infected sequestra.

There is contrast enhancement consistent with active infectious leptomeningitis or pachymeningitis.

There is contrast enhancement consistent with carcinomatous, tuberculous, or neurosarcoid-related pachymeningitis.

There is evidence of an intracranial CVT, or AV fistula (CC fistula, vein of Galen fistula) causing elevated venous pressure and hydrocephalus.

There is contrast parenchymal enhancement consistent with cerebritis or brain abscess, which can is some cases lead to ventricular obstruction.

Other significant imaging findings are present.