Case 38 - Overshunting

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

Examination: MRI Brain ultrafast

INDICATION: Concern for hydrocephalus. Patient is a 6-month-old male with increasing head circumference.

TECHNIQUE: Axial T2, sagittal T2, coronal T2, and diffusion images of the brain were obtained without contrast.

FINDINGS:

There is marked supratentorial ventriculomegaly, with mild increased T2 signal in the periventricular white matter. The cerebral aqueduct is patent. There is a mild enlargement of the fourth ventricle. Increased CSF volume within the posterior fossa, likely representing mega cisterna magna.

There is perforation of the septum pellucidum and hypoplasia or marked thinning of the corpus callosum.

The diffusion weighted image sequences reveal no restricted diffusion. Partially empty sella. The craniocervical junction is unremarkable. The included portions of the paranasal sinuses and orbits are unremarkable. Bilateral mastoid air cell effusion.

IMPRESSION:

1. Marked supratentorial ventriculomegaly, with mild periventricular white matter edema. The cerebral aqueduct is patent, and there is borderline enlargement of the fourth ventricle. No definite obstructing lesion identified.

2. Mega cisterna magna and normal vermis.

EXAMINATION: MRI brain ultrafast.

INDICATION: Hydrocephalus, status post excision placement.

TECHNIQUE: Triplanar T2 haste images of the brain performed without administration of contrast.

FINDINGS:

New right parietal approach ventriculostomy catheter terminating in the body of the right lateral ventricle. Mildly decreased severe ventriculomegaly since 3/4/2020, with decreasing bulbous contour of the lateral ventricular margins. Unchanged ruptured septum pellucidum.

New small bilateral subdural hygromas, greatest along the tentorial leaflets measuring 5 mm in depth on the left and 3 mm on the right. No mass effect. No midline shift. Stable prominent retrocerebellar CSF space, possibly an arachnoid cyst versus magna cisterna magna.

Basal cisterns are patent. Major intracranial flow voids are preserved. Stable marked thinning of the corpus callosum.

Mild mucosal thickening of the paranasal sinuses. Large bilateral mastoid effusions. Orbits are unremarkable.

IMPRESSION:

1. Placement of a right parietal approach ventriculostomy catheter terminating in the right lateral ventricle. Mildly decreased size of severe ventriculomegaly since 3/4/2020.

2. Trace bilateral subdural hygromas measuring up to 5 mm on the left and 3 mm on the right. No mass effect or midline shift

EXAM: MRI BRAIN ULTRAFAST

INDICATION: 13-month-old male with history of congenital hydrocephalus status post ventriculoperitoneal shunt placement 3/6/2020.

TECHNIQUE: Axial, sagittal and coronal T2 haste imaging of the brain.

COMPARISON: MRI brain ultrafast

FINDINGS:

Right occipital approach ventriculostomy catheter with tip at the frontal horn of the right lateral ventricle.

Marked interval decreased size of the supratentorial ventricles, now slitlike, previously markedly enlarged.

Interval development of large bilateral subdural collections demonstrating homogeneous T2 hyperintensity over the cerebral convexities, measuring up to 1.8 cm over the right frontal convexity and 1.6 cm over the left frontal convexity. Effacement of the sulci over the bilateral cerebral hemispheres.

Interval decreased size or resolution of subdural collection inferior to the cerebellar hemispheres bilaterally compared to 4/28/2020.

Basal cisterns are patent. Major intracranial vascular flow voids are preserved.

Redemonstration of diffuse periventricular white matter volume loss with thinning of the corpus callosum.

Bilateral orbits are symmetric and unremarkable. Scalp, calvarium and paranasal sinuses are unremarkable.

IMPRESSION:

1. Marked interval decreased size of the previously enlarged supratentorial ventricles, now slitlike.

2. Large bilateral subdural hygromas/effusions over the bilateral cerebral convexities, appearing since prior study 4/28/2020. Effacement of the sulci over the bilateral cerebral convexities. No midline shift.

3. Decreased size or resolution of subdural collection inferior to the bilateral cerebellar hemispheres since 4/28/2020.