13 month old female

Jason Dowling
Radiology Elective
April 21, 2005

Presentation

13 month old female with no significant PMH

HPI: Pt presents with 2-3wk h/o increased head circumference,
fussiness, lethargy, and refusal to stand.
PMI: NSVD without hydrocephalous at birth, otitis media, RSV
infection
FH: brittle bone disease
Labs: CBC and BMP normal
Work-up: CT at outside hospital showed non-communicating
hydrocephalous involving lateral and 3rd ventricle.

Radiology - axial T2

Radiology - sagital T1

Findings: dilatation of the

lateral and third ventricles
with periventricular fluid
normal fourth ventricle
distal aqueduct stenosis

Hospital Course

Pt received a endoscopic
third ventricular
ventriculostomy
MRI showed marked
decrease in ventricular size
post-op

Aqueduct of Sylvius Stenosis

Most common cause of hydrocephalus (20% of cases)

Incidence: 0.5-1.0 per 1000 births
Can be congenital or acquired following inflammatory or
neoplastic event
X-linked recessive form (rare)
Associated with spina bifida

Radiographic findings

Marked enlargement of the lateral ventricles, with interstitial

edema
Outpouching of the suprasellar recesses of the third ventricle
Ventricularization of the proximal aqueduct just above the level
of obstruction
Normal size and configuration of the fourth ventricle

Differntial Diagnosis

Congenital malformation
Post-infectious
Post-hemorrhage
Tumors
Other causes of hydrocephalus: communicating hydrocephalus,
malformations (Chiari type II, Dandy-Walker, Vein of Galen)

References

Behrman: Nelson Textbook of Pediatrics. 17th ed. Elsevier: 2004. Pg

1990.
Grainger & Allison's Diagnostic Radiology: A Textbook of Medical
Imaging, 4th ed. 2001 Churchill Livingstone, Inc. pg 2403.
Nard, JA. Abnormal head size and shape. In: Gartner, JC, Zitelli, BJ.
Common Chronic Symptoms in Pediatrics, Mosby, St. Louis, 1997.