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A 45 year old man presented with gait difficulty and falling. He had a history of a severe head injury ten years earlier.
(Left) Flair axial MRI Scan; (Middle and Right) Coronal T1-weighted MRIscans. Note that all the ventricles are dilated including the fourth ventricle. 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. In this case, the hydrocephalus likely resulted from the prior head injury and presumed bleeding at the time.
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