MyPACS.net: Radiology Teaching Files > Case 2710775

previously visited AQUEDUCTAL STENOSIS
Contributed by: Fritsch & Thompson, Radiologist, Diagnostic Radiology of Houston, Texas, USA.
Patient: 40 year old female
History: Unresolving headaches
Images:[small]larger

Fig. 1: T2 Sag

Fig. 2: T1 Sag without gadolinium

Fig. 3: T1 sag with gadolinium

Fig. 4: Normal T1 Sagittal brain MRI

Fig. 5: T2 axial

Fig. 6: T1 axial without gadolinium

Fig. 7: Normal T2 axial brain MRI

Fig. 8: T2 Coronal

Fig. 9: Normal T2 coronal brain MRI at level of basilar artery
Findings: Dilatation of the lateral and third ventricles with normal-sized fourth ventricle, with or without dilatation of the upper, not lower, poriton of the cerebral aqueduct.  With or without discrete or poorly-defined lesion in the midbrain.
Diagnosis: Aqueductal stenosis causing hydrocephalus.
Discussion:

Aqueductal stenosis can reult from a small lesion / neoplasm in the midbrain, debris or adhesions from hemorrhage or inflammatory diseases.  MRI can exclude other lesions causing obstruction of the CSF flow through the aqueduct; such as lesions in the posterior third ventricle or posterior cranial fossa.

In this case it is believed to be congenital since no lesions or direct conditions explain the finding.  No invasive procedure were performed to confirm.

References:

Referring Physician: Dennis Brown,MD - Neurology

Case Of the Week: 12/7/2005

MRI Case of the Week: 10/04/06

Comments:
Surgical treatment for SYMPTOMATIC aqueductal stenosis traditionally has been the creation of a ventriculo-peritoneal shunt. More recently, however, endoscopic third ventriculostomy or endoscopic aqueductoplasty/stent placement has been sucessful, and has been described as a valid alternative. Thus, this new approach avoids the need for a shunt which has a significantly higher infection rate. Peter Yeh, GULFCOASTBRAINANDSPINE.COM Bellaire,TX.--Peter Yeh, 2005-12-08
Additional Details:

Case Number: 2710775Last Updated: 01-08-2008
Anatomy: Cranium and Contents   Pathology: Congenital
Modality: MR, OtherExam Date: 09-10-2005Access Level: Readable by all users
Keywords: hydrocephalus, stenosis, aqueductus sylvius

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