Male, full-term 21 days old infant, with increasing head circumference and bulging fontanelle. Evaluate for aqueduct stenosis/hydrocephalus. The lateral ventricles are markedly dilated, right side greater than left, with moderate dilatation of the third ventricles. The fourth ventricle is normal in caliber.Subacute blood clot is evident dangling within the right lateral ventricle. Subacute subdural blood product is also seen along the left anterior temporal lobe and along the posterior cerebellum. On susceptibility weighted imaging, however, there is a much more extensive pattern of chronic hemosiderin staining along the ependymal surface of the ventricles, the choroid plexi, and the surface of the brainstem and the cerebellum.Marked ventriculomegaly causes deformation of the brain parenchyma and periventricular white matter thinning. The corpus callosum appears to be present but is severely thinned. No areas of acute ischemia or significant parenchymal edema are detected.The pituitary region is unremarkable. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed. The cerebral aqueduct is patent. The posterior aspect of the right thalamus is smaller than that of the left and there is signal abnormality suggesting gliosis. The pattern of white matter myelination is otherwise appropriate for age.
1.Marked supratentorial ventriculomegaly.2.Subacute blood clot within the right lateral ventricle and in the subdural spaces along the left anterior temporal lobe and the posterior cerebellum.3.Superficial hemosiderin staining along the ependymal surface of the ventricles as well as the surface of the brainstem and cerebellum indicating a fairly extensive prior hemorrhagic event.4.Volume loss and gliosis of the right posterior thalamus are seen possibly suggesting prior injury or insult.5.The cerebral aqueduct is patent.