Presentation
Cognitive impairment
Patient Data
Moderate dilated supra-tentorial ventricular system, with average-sized fourth ventricle. No evidence of periventricular CSF permeation.
The mamillo-pontine distance = 8.7 mm "increased".
Normal floor of the 3rd ventricle. Widened Sylvian fissures.
Scattered white matter T2 hyperintensities are noted mainly involving the periventricular area and centrum semiovale, reflecting deep white matter ischemic changes "Fazekas III".
Vertebrobasilar dolichoectasia (6mm diameter; Smoker's scoring of the basilar bifurcation: height grade II, and lateral grade I).
Bilateral mild maxillary sinusitis.
Ultra-thin 3D sagittal T2W shows patency of the aqueduct with accentuated flow within its lumen.
The estimated absolute stroke volume of around 306 microliters, is markedly increased.
Increased peak velocity averaging 8.48 cm/sec.
Case Discussion
MRI features are in favor of normal pressure hydrocephalus "NPH" with patent aqueduct showing accentuated CSF flow within its lumen; the markedly increased absolute stroke volume favors a good shunt responder.
Deep white matter ischemic changes "Fazekas III".
Case courtesy Prof.Dr. Ihab Reda, Professor of Radiology, Alexandria university, Egypt.
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