Case Images
Case Notes
History
21 yo male who present with persistent headaches after minor head injury.Exam
MR diffusion
Prior Study
T2-w spin-echo or noncontrast T1-w MR, noncontrast CT with scout skull image1. 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.
Post contrast T1-w MR
1. Unremarkable post contrast T1-w sequence, as above
MR susceptibility
1. Unremarkable MR susceptibility sequence, as above
Dicom
Findings
You scored:
0
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4
| MR Diffusion | Correct Answer | Your Answer |
|---|---|---|
|
There is subpial edema on the DWI to suggest leptomeningitis. |
No | NA |
|
There is cortical & subcortical edema to suggest cortical vein CVT. |
No | NA |
|
There intra or extra axial fluid collection with positive DWI consistent with fluid collection, or positive DWI & ADC consistent with organized empyema, abscess, or infected intraventricular sequestra. |
No | NA |
|
Other significant imaging findings are present. |
No | NA |
Impression
Expert Answer
Both of the above are true and neither is likely in arrested hydrocephalus.
Your Answer
Recommendations & Acuity
Recommendations
Expert Answer
Proceed with additional MR imaging sequences.
Your Answer
Acuity
Expert Answer
Emergent (Action Necessary now)
