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Phase-contrast cine MRI revealing en valve mechanism in spontaneous third ventriculostomy: report of a case and literature review.
[hydrocephalus with stenosis of the aqueduct of sylvius]
A
50
-
year
-old
epileptic
woman
affected
by
hydrocephalus
due
to
aqueductal
stenosis
was
admitted
to
the
hospital
because
of
headache
,
dysarthria
,
and
mild
lateral
pulsion
.
Cranial
computed
tomography
(
CT
)
revealed
left
cerebellar
hemorrhage
.
Subsequent
magnetic
resonance
imaging
(
MRI
)
of
the
brain
demonstrated
an
enlarged
ventricular
system
unchanged
from
prior
studies
.
Flow-sensitive
phase-contrast
(
PC
)
cine
magnetic
resonance
imaging
showed
flow
absence
through
the
aqueduct
and
flow
pulsations
through
the
third
ventricle
floor
in
systole
and
diastole
,
consistent
with
spontaneous
third
ventricle
patency
.
On
stationary
tissue
images
,
the
third
ventricle
floor
and
the
mamillary
body
were
displaced
downward
at
systole
and
upward
at
diastole
.
Stenosis
of
the
cerebral
aqueduct
of
Sylvius
was
also
shown
.
Retrospective
evaluation
of
the
sagittal
T
2
-
weighted
images
disclosed
flow
void
at
the
level
of
the
third
ventricle
floor
.
On-off
movements
of
the
third
ventricle
floor
could
account
for
chronic
hydrocephalus
persistence
by
an
en
valve
mechanism
.
Spontaneous
third
ventriculostomy
(
STV
)
was
diagnosed
on
the
basis
of
these
findings
.
STV
is
a
rare
condition
occurring
in
chronic
obstructive
hydrocephalus
patients
as
a
result
of
longstanding
pulsations
against
the
walls
of
the
third
ventricle
,
the
floor
in
particular
.
We
reviewed
the
literature
to
establish
which
imaging
and
clinical
findings
could
improve
the
identification
of
STV
in
patients
affected
by
obstructive
hydrocephalus
.
Diseases
Validation
Diseases presenting
"cerebellar hemorrhage"
symptom
cadasil
hydrocephalus with stenosis of the aqueduct of sylvius
This symptom has already been validated