Expanding lacunae causing triventricular hydrocephalus

Report of two cases

Mario Mascalchi M.D., Ph.D., Fabrizio Salvi M.D., Ph.D., Umberto Godano M.D., Marco Nistri M.D., Rosanna Taiuti M.D., Michela Tosetti Ph.D., Natale Villari M.D., and Fabrio Calbucci M.D.
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  • Sezione di Radiodiagnostica, Dipartimento di Fisiopatologia Clinica, Clinica Neurologica, Università di Firenze, Florence, Italy; Divisione di Neurologia, Divisione di Neurochirurgia, Dipartimento di Scienze Neurologiche, Ospedale Bellaria, Bologna, Italy; and IRCCS Stella Maris, Pisa, Italy
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Two patients are reported in whom the presence of triventricular hydrocephalus and aqueductal obstruction or stenosis due to multiple expanding lacunae in the mesencephalothalamic region possibly corresponds to abnormally dilated perivascular spaces. Placement of a ventriculoperitoneal cerebrospinal fluid (CSF) shunt in one patient and the performance of a third ventricle cisternotomy in the other reversed the hydrocephalic syndrome, but did not modify the complex neuroophthalmological disturbance and rubral tremor presumably related to the compressive effects of the lacunae on adjacent parenchyma. In one patient the number and size of the lacunae were increased 4 years after CSF shunt placement. A review of the literature revealed two cases in which magnetic resonance imaging demonstrated a similar, poorly understood pathological condition.

Two patients are reported in whom the presence of triventricular hydrocephalus and aqueductal obstruction or stenosis due to multiple expanding lacunae in the mesencephalothalamic region possibly corresponds to abnormally dilated perivascular spaces. Placement of a ventriculoperitoneal cerebrospinal fluid (CSF) shunt in one patient and the performance of a third ventricle cisternotomy in the other reversed the hydrocephalic syndrome, but did not modify the complex neuroophthalmological disturbance and rubral tremor presumably related to the compressive effects of the lacunae on adjacent parenchyma. In one patient the number and size of the lacunae were increased 4 years after CSF shunt placement. A review of the literature revealed two cases in which magnetic resonance imaging demonstrated a similar, poorly understood pathological condition.