Answer:
Normal Pressure Hydrocephalus
Findings
Ventriculosulcal disproportion Accentuated CSF Flow void (Aqueductal Flow Void Sign) in the Cerebral Aqueduct. CSF Flow artefacts in the third and fourth ventricles
DiscussionNormal Pressure Hydrocephalus (also Hakim`s Disease) is an important treatable cause of Dementia in the elderly. Normal pressure hydrocephalus (NPH) is a communicating hydrocephalus often resulting from impaired reabsorption of CSF into the venous sinuses due to previous meningitis, encephalitis, subarachnoid hemorrhage, or trauma. However many cases remain idiopathic. The typical features in MRI are the Ventriculosulcal disproportion and Accentuated CSF Flow void (Aqueductal Flow Void Sign) in the Cerebral Aqueduct. The sylvian cisterns are prominent. There may be CSF Flow artefacts in the third and fourth ventricles. Other findings described are thinning of corpus callosum and reduced Mammillo pontine distance (<6mm)PC CSF Flow Velocity imaging may show increased flow in the Aqueduct . The peak caudal and rostral flow and velocities are significantly increased. The purpose of Flow Quantification is to identify those patients who respond to Shunting . Those with Stroke Volume greater than 42 microlitre respond well to shunting . MR Spectroscopy may reveal increased Intraventricular lactate.
Contributed By: Dr. Babu Peter MD. DNB
Associate Professor, Barnard Institute of Radiology, Chennai
Senior Consultant Radiologist, Aarthi Scans, Chennai
Normal Pressure Hydrocephalus
Findings
Ventriculosulcal disproportion Accentuated CSF Flow void (Aqueductal Flow Void Sign) in the Cerebral Aqueduct. CSF Flow artefacts in the third and fourth ventricles
DiscussionNormal Pressure Hydrocephalus (also Hakim`s Disease) is an important treatable cause of Dementia in the elderly. Normal pressure hydrocephalus (NPH) is a communicating hydrocephalus often resulting from impaired reabsorption of CSF into the venous sinuses due to previous meningitis, encephalitis, subarachnoid hemorrhage, or trauma. However many cases remain idiopathic. The typical features in MRI are the Ventriculosulcal disproportion and Accentuated CSF Flow void (Aqueductal Flow Void Sign) in the Cerebral Aqueduct. The sylvian cisterns are prominent. There may be CSF Flow artefacts in the third and fourth ventricles. Other findings described are thinning of corpus callosum and reduced Mammillo pontine distance (<6mm)PC CSF Flow Velocity imaging may show increased flow in the Aqueduct . The peak caudal and rostral flow and velocities are significantly increased. The purpose of Flow Quantification is to identify those patients who respond to Shunting . Those with Stroke Volume greater than 42 microlitre respond well to shunting . MR Spectroscopy may reveal increased Intraventricular lactate.
Contributed By: Dr. Babu Peter MD. DNB
Associate Professor, Barnard Institute of Radiology, Chennai
Senior Consultant Radiologist, Aarthi Scans, Chennai