Documentation of fourth ventricle entrapment by metrizamide ventriculography with CT scanning

Report of two cases

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✓ Documentation by metrizamide ventriculography with computerized tomography (CT) of fourth ventricle entrapment is presented. Reevaluation of the cerebrospinal fluid pathways is suggested whenever fourth ventricle enlargment is seen on CT scans of patients with ventriculoperitoneal shunts for communicating hydrocephalus.

Article Information

Address reprint requests to: Mauricio Collada, Jr., M.D. Department of Neurosurgery, Louisiana State University Medical Center, 1542 Tulane Avenue, New Orleans, Louisiana 70112.

© AANS, except where prohibited by US copyright law.

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    Case 1. Left: Plain CT scan obtained on admission shows the ventricular system is enlarged. The fourth ventricle is disproportionately enlarged, suggesting fourth ventricle entrapment. Right: After the administration of metrizamide, the contrast medium flows easily through the supratentorial portion of the ventricular system but never fills the fourth ventricle.

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    Case 2. Left: Plain computerized tomography scan showing enlargement of the ventricular system. The fourth ventricle appears disproportionately large, suggesting entrapment. Center: On administration of metrizamide, the contrast medium fills the entire ventricular system, and the fourth ventricle fills completely, showing that no obstruction of the aqueduct exists. Right: Postshunt CT scan shows an appropriate reduction in the size of the entire ventricular system.

References

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