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A 75 year old woman presented with gait difficulty, urinary incontinence and difficulty with concentration.
Axial MRI flair images. Hydrocephalus is recognized as enlarged ventricles out of proportion to the amount of cerebral atrophy (i.e., hydrocephalus ex vacuo). Communicating hydrocephalus occurs then the ventricular system is in continuity with the subaranchoid space and all the ventricles are enlarged, including the fourth ventricle. Note the prominent trans-ependymal edema in the white matter surrounding the ventricles. In this case, the CSF opening pressure was within the normal range. This patient had normal pressure hydrocephalus, a condition that can be confused with primary dementing disorders.
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