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Stefania Filippi, Pierfrancesco Monaco, Umberto Godano, and Fabio Calbucci

✓ The case of a 50-year-old man with tetraventricular hypertensive hydrocephalus is presented, remarkable for fourth ventricle dilatation. This patient showed a significant sialorrhea as the main symptom, which is quite unusual. This condition was successfully treated by cerebrospinal fluid diversion. The uncommon features of this case are summarized.