CT and MRI

In order to more fully evaluate the entire ventricular system and investigate the underlying etiology of hydrocephalus, CT or MRI scanning is required. Clearly, there is a range of normal ventricular size and, indeed, ventricular size changes with age, rendering absolute measurements of ventricular dimensions of little use. No single radiological parameter can be relied upon to distinguish hydrocephalus from the other causes of ventricular enlargement mentioned above. Some features, however, are strongly suggestive, particularly when occurring in combination. Enlargement of the temporal horns of the lateral ventricles and enlargement of the third ventricle, commensurate with the enlargement of the rest of the ventricular system, are findings in favor of hydrocephalus. Obliteration of the basal cisterns and effacement of the cortical sulci further support a diagnosis of hydro-cephalus. When the ventricles are under pressure, there may be transependymal flux of CSF into the periventricular parenchyma, particularly at the tips of the frontal occipital and temporal horns. This appears as low density on CT scan or a rim of high signal intensity on the T2-weighted MRI scan (Fig. 24.2).

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