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Non-communicating Hydrocephalus - Prematurity

A 1 year-old boy developed an enlarged head. He had been born prematurely, with an intraventricular hemorrhage at birth.

Show the Enlarged Ventricles                     Show the Thin Cortical Ribbon

Non-Communicating Hydrocephalus: Axial CT scans. Note the massive enlargement of the lateral and third ventricles. This pattern is one of non-communicating (obstructive) hydrocephalus, which occurs from impaired drainage through the cerebral aqueduct which connects the third and fourth ventricles. This picture differs from communicating hydrocephalus wherein all the ventricles are enlarged. Note that the cortical ribbon is extremely thin near the skull, from the constant pressure of the underlying obstructive hydrocephalus. Before the bony sutures of the skull have fused in a child, hydrocephalus may present as progressive and abnormal enlargement of the head (macrocephaly). In this case, the cause of the hydrocephalus was likely the intraventricular hemorrhage associated with premature birth, with subsequent scarring and gliosis of the cerebral aqueduct.

Hydrocephalus is recognized as enlarged ventricles out of proportion to the amount of cerebral atrophy. Non-communicating (obstructive) hydrocephalus occurs when the ventricular system is not in continuity with the subarachnoid space. Most often, the site of the blockage in non-communicating hydrocephalus is at the cerebral aqueduct, but rarely can occur at the foramen of Monro, the third ventricle, or the outlet of the fourth ventricle. Acute non-compensated, non-communicating (obstructive) hydrocephalus is a neurosurgical emergency as the non-compensated hydrocephalus results in a progressive increase in intracranial pressure, which if left unchecked will result in herniation and brain death. It is potentially treatable by shunting.


Revised 11/23/06
Copyrighted 2006. David C Preston