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Large Spaces!

Topic: Adult

Created on Saturday, November 8 2008 by rednucleus

Last modified on Saturday, November 8 2008.

You are reviewing the brain MRI of a 61-year-old man with vague personality changes and abnormal gait. You see dilated ventricular system and your intern thinks that this is compensatory to global brain atrophy. However, you have detected something that indicates this hydrocephalus is not due to brain atrophy. What have you seen?

A) Marked enlargement of choroidal-hippocampal fissures

B) Normal temporal horns

C) Mamillo-pontine distance of 2.1 cm

D) Flow void in the aqueduct

E) Concave 3rd ventricle

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This question was created on November 08, 2008 by rednucleus.
This question was last modified on November 08, 2008.

ANSWERS AND EXPLANATIONS

A) Marked enlargement of choroidal-hippocampal fissures

This answer is incorrect.

This is highly suggestive of Alzheimer’s; normal or mildly enlarged ones are seen with hydrocephalus. (See References)


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B) Normal temporal horns

This answer is incorrect.

The temporal horns are NOT dilated in brain atrophy (expect in Alzheimer’s disease); dilated ones indicate hydrocephalus. (See References)


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C) Mamillo-pontine distance of 2.1 cm

This answer is incorrect.

Dilated ventricular system with mamillo-pontine distance greater than 1.0 cm indicates brain atrophy; a distance less than 1.0 cm is more compatible with hydrocephalus. (See References)


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D) Flow void in the aqueduct

This answer is correct.

This is seen in normal pressure hydrocephalus due to aggressive CSF flow. This finding, previously, was thought to predict a favorable response to shunting; however, this is not true nowadays. One of the most difficult questions to answer in normal pressure hydrocephalus is that who will respond to shunting? (See References)


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E) Concave 3rd ventricle

This answer is incorrect.

Seen when the ventricular system is dilated due to brain atrophy; a convex one occurs in hydrocephalus. Note that the 4th ventricle could be normal or enlarged in hydrocephalus (according the cause) while it is typically normal in brain atrophy (except when there is marked cerebellar atrophy). (See References)


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References:

1. Victor, M., and Ropper, A.H. (2001). Adams and Victor's Principles of Neurology, 7th Edition. McGraw-Hill, New York. (ISBN:0070674973)

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adult
Large Spaces!
Question ID: 110808108
Question written by rednucleus. (C) FrontalCortex.com 2006-2009, all rights reserved. Created: 11/08/2008
Modified: 11/08/2008
Estimated Permutations: 120