Question

79 year old male with headaches, ataxia, falls, and difficulty urinating. What's the diagnosis?

Answer

Diagnosis: Ventriculomegaly secondary to Normal Pressure Hydrocephalus

 

An approach to ventriculomegaly

Ventriculomegaly is due to cerebral atrophy (e.g., Parkinson disease) or increased cerebrospinal fluid (CSF) within the ventricles. Increased CSF is due to:

• Increased CSF production (e.g., choroid-plexus papilloma), or
• Impaired CSF re-absorption (e.g., subarachnoid-villi inflammation), or
• Obstruction of CSF flow (e.g., non-communicating hydrocephalus)

Congenital causes of ventriculomegaly:

• Neuro-tube defect (e.g, myelomeningocele)
• Aquaductal stenosis
• CNS malformation (e.g., Dandi-Walker syndrome)
• Intrauterine infection (e.g., CMV, rubella, etc.)

Acquired causes of ventriculomegaly:

• Paget's disease (obstruction of CSF flow)
• Bacterial or viral meningitis (impaired CSF absorption)
• Tumor (obstruction of CSF flow)
• Post-hemorrhagic (e.g., trauma, aneurysmal rupture, AVM, coagulopathy) impaired absorption and/or obstruction of flow