17 month old male with ventriculomegaly and porencephalic cyst experiencing continued increasing head circumference. Evaluate for aqueductal stenosis. Sagittal T1 and T2 images demonstrate narrowing of the mid point of the cerebral aqueduct due to dysmorphism of the adjacent quadrigeminal plate. Minimal biphasic CSF flow is identified at the level of the aqueduct and fourth ventricle, although normal biphasic flow is noted anteriorly and at the level of the cerebellar tonsils.Redemonstrated is a right transfrontal Rickham catheter that terminates in a large right frontal lobe porencephalic cyst. The porencephalic cyst, lateral ventricles, and third ventricle have continued to increased in size, although this seems commensurate with calvarial growth. There remain a few scattered foci of residual susceptibility effect within and along the margins of the ventricular system and perhaps within the right prepontine cistern, unchanged. Also redemonstrated is diffuse cerebral white matter volume loss. There is no evidence of acute intracranial hemorrhage or acute infarct. There is approximately 5 mm midline shift to the left. The major cerebral flow voids appear to be intact. The cranial vault appears macrocephalic. Mastoid air cells and middle ear cavities are clear.
Sagittal T1 and T2 images demonstrate narrowing of the mid point of the cerebral aqueduct due to dysmorphism of the adjacent quadrigeminal plate. Minimal biphasic CSF flow is identified at the level of the aqueduct and fourth ventricle, although normal biphasic flow is noted anteriorly and at the level of the cerebellar tonsils.