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Non-communicating Hydrocephalus - Acute Shunt Malfunction

A 32 year-old man with a ventriculoperitoneal shunt presented with headaches and progressive confusion.

Show the Enlarged 3rd and Lateral Ventricles                                   Show the Normal Size 4th Ventricle

Coronal MRI T1-weighted scan with Gadolinium. Note the marked enlargement of the lateral and third ventricles. However, the fourth ventricle is normal size. This pattern is one of obstructive hydrocephalus, which occurs from impaired drainage through the cerebral aqueduct (connecting the third to the fourth ventricles).  In this patient, this was a chronic condition since a childhood episode of head trauma. He had been successfully treated with a shunt. However, when the shunt malfunctioned, acute hydrocephalus developed resulting in marked symptoms. This is a neurosurgical emergency. Also note the incidental finding of a well seen basilar artery and superior cerebellar artery on the scan on the left.

Revised 04/21/06.
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