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Chapter 22: Pathology of the Nervous System

A 22-year-old woman presents with a 2-month history of worsening headaches, vomiting, lethargy, and blurry vision. At the hospital, the neuroradiologist notes ventriculomegaly, periventricular interstitial edema, a third ventricular cyst, and a small enhancing lesion (yellow arrow) in the posterior body of the corpus callosum on MRI (Figure 22-51).

The clinical history of headache, nausea, and vomiting in a patient with MRI-documented ventriculomegaly is consistent with:

FIGURE 22-51

Midsagittal T1-weighted MRI with contrast enhancement.

A. Hydrocephalus ex vacuo

B. Increased intracranial pressure

C. NPH

D. Uncal herniation

Answer: B

Explanation: This case does not show the brain atrophy associated with hydrocephalus ex vacuo. NPH is evidenced clinically by the triad of dementia, gait ataxia, and urinary incontinence. Patient does not have decreased mental state, dilated pupil, and hemiplegia of the uncal herniation syndrome.

A 22-year-old woman presents with a 2-month history of worsening headaches, vomiting, lethargy, and blurry vision. At the hospital, the neuroradiologist notes ventriculomegaly, periventricular interstitial edema, a third ventricular cyst, and a small enhancing lesion (yellow arrow) in the posterior body of the corpus callosum on MRI (Figure 22-51).

The MRI scan (Figure 22-51) in this patient shows:

A. An enlarged fourth ventricle

B. Communicating hydrocephalus

C. Hydrocephalus ex vacuo

D. Noncommunicating hydrocephalus

Answer: D

Explanation: Fourth ventricle is not enlarged, thus CSF pathway obstruction is between enlarged lateral and third ventricles and the normal fourth ventricle, making this a noncommunicating hydrocephalus. This case does not show the brain atrophy associated with hydrocephalus ex vacuo.

This 82-year-old man in a nursing home is transported by ambulance to the local ED immediately after a witnessed fall. The patient’s medical history is significant for longstanding Alzheimer disease. A noncontrasted head CT is performed (Figure 22-52).

The CT in this patient shows:

FIGURE 22-52

Unenhanced axial CT. Source: Courtesy of Huang B, MD Department of Radiology, UNC School of Medicine.

A. Acute global hypoxic-ischemic encephalopathy with diffuse cerebral edema

B. Noncommunicating hydrocephalus

C. Hydrocephalus ex vacuo

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