differential diagnosis of hydrocephalus by: nour-eldin mohammed ref : radiological differential...
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Differential Diagnosis of Differential Diagnosis of HydrocephalusHydrocephalus
By:
Nour-Eldin Mohammed
Ref : Radiological Differential Diagnosis : Stephen Chapman,2003
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The Normal CSF FlowThe Normal CSF Flow
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HydrocephalusHydrocephalusAbnormal dilatation of the cerebral
ventricular systemHydrocephalus should be
differentiated from disorders producing ventricular enlargement secondary to cerebral atrophy.
Classified into :1.Communicating Hydrocephalus2.Non communicating Hydrocephalus
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Characterisics of Characterisics of HydrocephalusHydrocephalusVentricular enlargement
disproportionate to the degree of sulcal widening
Enlagement of temporal hornePeriventricular fluid 2ry to
transependymal CSF permeationEnlarged 3rd ventricle with large
suprapineal and chiasmatic recesesIn children < 2 years the head
circumference is often the best distinguishing feature between hydrocephalus and atrophy.
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Normal CT BrainHydrocephalic Brain
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Subependymal Subependymal CSF permeationCSF permeation
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Non-Communicating Non-Communicating Hydrocephalus (Intraventricular Hydrocephalus (Intraventricular obstruction)obstruction)Ventricular dilatation caused by
intraventricular obstruction at or above the the outlet foramina of the 4th ventricle
Causes:1.Lateral ventricle2.Foramen of Monro3.3rd ventricle4.Aqueduct of sylvius5.4th ventricle
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Lateral Ventriclar causes:Lateral Ventriclar causes:
1. Intrinsic tumor: ependymoma2. Ventriculitis: due to
intraventricular adhesions3. Extraventricular Tumour: mass
effect from large parenchymal mass
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Ventriculitis case 1 Ventriculitis case 2
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Neuroepithelial Cyst
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Obstruction of Foramen of Obstruction of Foramen of Monro:Monro:1. Tumour : colloid cyst ,
subependymal giant cell astrocytoma
2. Ventriculitis3. Haemorrhage : fresh clot , or
adhesive arachnoiditis4. Cerebral swelling with subfalcine
herniation
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Subependymal Giant cell astrocytoma
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Subependymal giant cell astrocytoma
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Central Neuocytoma
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Colloid cyst
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Colloid cyst
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Subfalcine Herniation :Subfalcine Herniation :
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Causes of Thid Ventricle Causes of Thid Ventricle Obstruction:Obstruction:
1. Intraventricular Tumor2. Extraventricular tumour :
Pituitary adenoma , craniopharyngioma, arachnoid cyst.
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Pituitary Adenoma
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Craniopharyngioma :Craniopharyngioma :
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Causes of Cerebral Aqueduct Causes of Cerebral Aqueduct of Sylvius Obstruction:of Sylvius Obstruction:1. Developmental aqueduct
stenosis2. Intraventricular tumour:
epndymal seedling3. Extraventricular Tumour : Pineal
Body tumour4. Ventriculitis5. Haemorrhage
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Aqueduct Stenosis
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Pineal Body Tumours:Pineal Body Tumours:
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Pineal Body Tumour:Pineal Body Tumour:
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44thth Ventricle obstruction : Ventricle obstruction :
1. Intraventricular Tumour: Ependymoma, metastases
2. Extraventricular Tumours: medulloblastoma, haemangioblastoma, cerebellopontine angle tumours (acoutic neuroma) , meningioma
3. Outflow obstrction: infection (TB), SAH, leptomeningeal malignancy
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EpendymomaEpendymoma
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Medulloblastoma :Medulloblastoma :
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Cerebellar Cerebellar HaemangioblastomHaemangioblastomaa
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Intraventricular Intraventricular Haemorrhage:Haemorrhage:
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Acoustic Neuroma:Acoustic Neuroma:
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Communicating Communicating Hydrocephalus:Hydrocephalus:There is free flow throughout the
ventricular system.Impaired CSF resorption by the
arachnoid granulation accounts for majority of cases
1.SAH2.Infectious meningitis3.Malignant meningitis4.Granulomatous mningitis : TB ,
sarcoidosis5.Altered venous Dynamics : Vein of
Galen malformation, venous obstruction
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TB Meningitis :TB Meningitis :
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Vein of Galen :Vein of Galen :
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Vein of Galen
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Thank you