Transcript Differential Diagnosis of Hydrocephalus

Differential Diagnosis of
Hydrocephalus
By:
Nour-Eldin Mohammed
Ref : Radiological Differential Diagnosis : Stephen Chapman,2003
The Normal CSF Flow
Hydrocephalus
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
Abnormal dilatation of the cerebral
ventricular system
Hydrocephalus should be differentiated from
disorders producing ventricular enlargement
secondary to cerebral atrophy.
Classified into :
1. Communicating Hydrocephalus
2. Non communicating Hydrocephalus

Characterisics of Hydrocephalus
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Ventricular enlargement disproportionate to
the degree of sulcal widening
Enlagement of temporal horne
Periventricular fluid 2ry to transependymal
CSF permeation
Enlarged 3rd ventricle with large suprapineal
and chiasmatic receses
In children < 2 years the head circumference
is often the best distinguishing feature
between hydrocephalus and atrophy.
Hydrocephalic Brain
Normal CT Brain
Subependymal CSF
permeation
Non-Communicating Hydrocephalus
(Intraventricular obstruction)
Ventricular dilatation caused by
intraventricular obstruction at or above the
the outlet foramina of the 4th ventricle
 Causes:
1. Lateral ventricle
2. Foramen of Monro
3. 3rd ventricle
4. Aqueduct of sylvius
5. 4th ventricle

Lateral Ventriclar causes:
1.
2.
3.
Intrinsic tumor: ependymoma
Ventriculitis: due to intraventricular
adhesions
Extraventricular Tumour: mass effect
from large parenchymal mass
Ventriculitis case 1
Ventriculitis case 2
Neuroepithelial Cyst
Obstruction of Foramen of Monro:
1.
2.
3.
4.
Tumour : colloid cyst , subependymal
giant cell astrocytoma
Ventriculitis
Haemorrhage : fresh clot , or adhesive
arachnoiditis
Cerebral swelling with subfalcine
herniation
Subependymal Giant
cell astrocytoma
Subependymal giant cell
astrocytoma
Central
Neuocytoma
Colloid cyst
Colloid cyst
Subfalcine Herniation :
Causes of Thid Ventricle
Obstruction:
1.
2.
Intraventricular Tumor
Extraventricular tumour : Pituitary
adenoma , craniopharyngioma, arachnoid
cyst.
Pituitary Adenoma
Craniopharyngioma :
Causes of Cerebral Aqueduct of
Sylvius Obstruction:
1.
2.
3.
4.
5.
Developmental aqueduct stenosis
Intraventricular tumour: epndymal
seedling
Extraventricular Tumour : Pineal Body
tumour
Ventriculitis
Haemorrhage
Aqueduct Stenosis
Pineal Body Tumours:
Pineal Body Tumour:
4th Ventricle obstruction :
1.
2.
3.
Intraventricular Tumour: Ependymoma,
metastases
Extraventricular Tumours:
medulloblastoma, haemangioblastoma,
cerebellopontine angle tumours (acoutic
neuroma) , meningioma
Outflow obstrction: infection (TB), SAH,
leptomeningeal malignancy
Ependymoma
Medulloblastoma :
Cerebellar
Haemangioblastoma
Intraventricular Haemorrhage:
Acoustic Neuroma:
Communicating Hydrocephalus:
There is free flow throughout the ventricular
system.
 Impaired CSF resorption by the arachnoid
granulation accounts for majority of cases
1. SAH
2. Infectious meningitis
3. Malignant meningitis
4. Granulomatous mningitis : TB , sarcoidosis
5. Altered venous Dynamics : Vein of Galen
malformation, venous obstruction

TB Meningitis :
Vein of Galen :
Vein of Galen
Thank you