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Hydrocephalus diagnosis

Imaging plays a central role in the diagnosis of hydrocephalus. While magnetic resonance (MR) imaging is the first-line imaging modality, computed tomography (CT) is often the first-line imaging test in emergency patients.

The MR imaging protocol should always include sagittal high-resolution T2-weighted images.

When an inflammatory etiology is suspected, imaging with contrast agent administration is necessary. 1).

Hydrocephalus causes transependymal resorption of spinal fluid that in turn produces periventricular interstitial transependymal edema.

The features of reelin expression in the brain of fetuses and newborns at 22-40 weeks' gestation with internal hydrocephalus should be considered as morphological differential and diagnostic criteria for the disease in relation to its etiology 2).


Ultrasound imaging, which uses high-frequency sound waves to produce images, is often used for an initial assessment for infants because it's a relatively simple, low-risk procedure. The ultrasound device is placed over the soft spot (fontanel) on the top of a baby's head. Ultrasound may also detect hydrocephalus prior to birth when the procedure is used during routine prenatal examinations.

Magnetic resonance imaging cisternography

In a study, Roth et al., described the experience with Magnetic resonance imaging cisternography (MRIC) or ventriculography (MRIV) for diagnosing or excluding intra- and extraventricular obstructions. Such a differentiation may have a significant impact on choosing the optimal surgical solution.

They retrospectively collected data on patients undergoing MRIC/MRIV for diagnosing or excluding obstructions in patients with ventriculomegaly. All patients had MRI suggesting an obstruction, but without a clear cause.

Five children aged 1-17 years were included (3 females). Four underwent an MRIV, and 1 underwent an MRIC. Three children presented with headaches and had a suspected prior endoscopic third ventriculostomy (ETV) failure, and 2 presented with macrocephalus and increasing head circumferences. MRIV showed a patent ETV stoma in 2 cases, one of which had a T2 SPACE MRI showing no flow void through the stoma, and a closed stoma in 1 case with a flow void above and below the stoma on T2 SPACE MRI. MRIV and MRIC differentiated between two cases with panventriculomegaly, one of which had an obstruction at the level of the Liliequist membrane, and another with no identifiable obstruction.

MRIC and MRIV have a complementary role to MRI in assessing selected patients with hydrocephalus suspected of being secondary to an obstruction, but with no clear obstruction location 3).


Langner S, Fleck S, Baldauf J, Mensel B, Kühn JP, Kirsch M. Diagnosis and Differential Diagnosis of Hydrocephalus in Adults. Rofo. 2017 May 16. doi: 10.1055/s-0043-108550. [Epub ahead of print] PubMed PMID: 28511266.
Protsenko EV, Vasil'eva ME, Peretyatko LP. [Specific features of reelin expression in the brain of fetuses and newborns with internal hydrocephalus]. Arkh Patol. 2016;78(1):3-7. Russian. PubMed PMID: 26978229.
Roth J, Constantini S, Ben-Sira L, Shiran SI. The Added Value of Magnetic Resonance Imaging Cisternography and Ventriculography as a Diagnostic Aid in Pediatric Hydrocephalus. Pediatr Neurosurg. 2019 Mar 14:1-8. doi: 10.1159/000497147. [Epub ahead of print] PubMed PMID: 30870836.
hydrocephalus_diagnosis.txt · Last modified: 2019/03/15 12:20 by administrador