Differential Diagnosis of

Hydrocephalus

By:

Nour-Eldin Mohammed

Ref : Radiological Differential Diagnosis : Stephen Chapman,2003

The Normal CSF Flow
Hydrocephalus
 Abnormal dilatation of the cerebral
ventricular system
 Hydrocephalus should be differentiated from
disorders producing ventricular enlargement
secondary to cerebral atrophy.

 Classified into :
1. Communicating Hydrocephalus
2. Non communicating Hydrocephalus
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 < 2 years the head circumference
is often the best distinguishing feature
between hydrocephalus and atrophy.
Hydrocephalic Brain Normal CT Brain
Subependymal CSF
permeation
Non-Communicating Hydrocephalus
(Intraventricular obstruction)
 Ventricular dilatation caused by
intraventricular obstruction at or above the
the outlet foramina of the 4th ventricle
 Causes:
1. Lateral ventricle
2. Foramen of Monro
3. 3rd ventricle
4. Aqueduct of sylvius
5. 4th ventricle
Lateral Ventriclar causes:
1. Intrinsic tumor: ependymoma
2. Ventriculitis: due to intraventricular
adhesions
3. Extraventricular Tumour: mass effect
from large parenchymal mass
Ventriculitis case 1 Ventriculitis case 2
Neuroepithelial Cyst
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
Subependymal Giant
cell astrocytoma
Subependymal giant cell
astrocytoma
Central
Neuocytoma
Colloid cyst
Colloid cyst
Subfalcine Herniation :
Causes of Thid Ventricle
Obstruction:

1. Intraventricular Tumor
2. Extraventricular tumour : Pituitary
adenoma , craniopharyngioma, arachnoid
cyst.
Pituitary Adenoma
Craniopharyngioma :
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
Aqueduct Stenosis
Pineal Body Tumours:
Pineal Body Tumour:
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
Ependymoma
Medulloblastoma :
Cerebellar
Haemangioblastoma
Intraventricular Haemorrhage:
Acoustic Neuroma:
Communicating Hydrocephalus:
 There is free flow throughout the ventricular
system.
 Impaired CSF resorption by the arachnoid
granulation accounts for majority of cases
1. SAH
2. Infectious meningitis
3. Malignant meningitis
4. Granulomatous mningitis : TB , sarcoidosis
5. Altered venous Dynamics : Vein of Galen
malformation, venous obstruction
TB Meningitis :
Vein of Galen :
Vein of Galen
Thank you