Differential Diagnosis of Hydrocephalus

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Differential Diagnosis of Hydrocephalus

• By
• Nour-Eldin Mohammed
• Ref Radiological Differential Diagnosis
  Stephen Chapman,2003

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The Normal CSF Flow
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Hydrocephalus

• Abnormal dilatation of the cerebral ventricular
  system
• Hydrocephalus should be differentiated from
  disorders producing ventricular enlargement
  secondary to cerebral atrophy.
• Classified into
• Communicating Hydrocephalus
• Non communicating Hydrocephalus

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Characterisics of Hydrocephalus

• Ventricular enlargement disproportionate to the
  degree of sulcal widening
• Enlagement of temporal horne
• Periventricular fluid 2ry to transependymal CSF
  permeation
• Enlarged 3rd ventricle with large suprapineal and
  chiasmatic receses
• In children lt 2 years the head circumference is
  often the best distinguishing feature between
  hydrocephalus and atrophy.

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Hydrocephalic Brain
Normal CT Brain
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Subependymal CSF permeation
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Non-Communicating Hydrocephalus (Intraventricular
obstruction)

• Ventricular dilatation caused by intraventricular
  obstruction at or above the the outlet foramina
  of the 4th ventricle
• Causes
• Lateral ventricle
• Foramen of Monro
• 3rd ventricle
• Aqueduct of sylvius
• 4th ventricle

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Lateral Ventriclar causes

1. Intrinsic tumor ependymoma
2. Ventriculitis due to intraventricular adhesions
3. 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 Monro

1. Tumour colloid cyst , subependymal giant cell
   astrocytoma
2. Ventriculitis
3. Haemorrhage fresh clot , or adhesive
   arachnoiditis
4. 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
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Causes of Thid Ventricle Obstruction

1. Intraventricular Tumor
2. Extraventricular tumour Pituitary adenoma ,
   craniopharyngioma, arachnoid cyst.

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Pituitary Adenoma
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Craniopharyngioma
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Causes of Cerebral Aqueduct of Sylvius
Obstruction

1. Developmental aqueduct stenosis
2. Intraventricular tumour epndymal seedling
3. Extraventricular Tumour Pineal Body tumour
4. Ventriculitis
5. Haemorrhage

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Aqueduct Stenosis
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Pineal Body Tumours
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Pineal Body Tumour
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4th 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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Ependymoma
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Medulloblastoma
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Cerebellar Haemangioblastoma
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Intraventricular Haemorrhage
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Acoustic Neuroma
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Communicating Hydrocephalus

• There is free flow throughout the ventricular
  system.
• Impaired CSF resorption by the arachnoid
  granulation accounts for majority of cases
• SAH
• Infectious meningitis
• Malignant meningitis
• Granulomatous mningitis TB , sarcoidosis
• Altered venous Dynamics Vein of Galen
  malformation, venous obstruction

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TB Meningitis
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Vein of Galen
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Vein of Galen
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Thank you