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A 79 year old woman presented with gait difficulty and falling. She was brought into the emergency room confused.
Axial CT scans. Note that all the ventricles are dilated including the fourth ventricle (left image). Also, note teh temporal horns which are dilated. 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. Also note that this patient has a small sudural (right image) that likely resulted from her fall.
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