 Limited examination secondary to motion artifact.There is marked dilatation of the lateral ventricles with a moderately dilated third ventricle and only a thin mantle of cerebral cortex, although distinct lobes are identified. A portion of the medial left posterior lateral ventricle herniates inferiorly into the posterior fossa along the medial margin of the left tentorium cerebelli. A thin septation or minimal debris is present in the inferior aspect of the left lateral ventricle extending towards midline (series 801, image 13). The fourth ventricle is normal in size. On available thin section parasagittal images, there is soft tissue fullness involving the tectal plate and the cerebral aqueduct is not well seen, concerning for obstruction.The thalami are present and appear unfused. The septum pellucidum is absent. The corpus callosum is not well assessed, but may be present perhaps significantly thinned by the enlarged ventricles. The intraorbital optic nerves are present and appear grossly unremarkable. The optic chiasm is suboptimally evaluated secondary to the diminished suprasellar cistern from the enlarged third ventricle, although is likely present as well. The pituitary gland is identified and appears within normal limits for age.No areas of diffusion restriction are seen to suggest acute or subacute ischemia. No areas of gradient susceptibility are demonstrated to suggest intracranial hemorrhage. The flow voids of the intracranial vasculature grossly unremarkable as well.Along the lower cervical cord, the sagittal T1W images of the brain appear to suggest trace T1 hypointensity centrally. The sagittal thin section images in the midline appear to suggest diminished caliber of the visualized upper thoracic cord, especially as compared to the cervical cord caliber.
1. Findings are most compatible with severe chronic hydrocephalus with concern for soft tissue prominence along the tectal plate, which may be obstructing the cerebral aqueduct. Further evaluation with CSF flow study and thin section sagittal midline 3D T2 images is recommended. Holoprosencephaly is considered unlikely given absence of fused thalami; septo-optic dysplasia is felt to be unlikely given that the pituitary gland is unremarkable and optic nerves are present. 2. Questioned trace syrinx in lower cervical cord and diminutive caliber of the upper thoracic cord, although incompletely evaluated. MRI of the cervical spine and thoracic spine recommended for a full evaluation.