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Increased Intracranial Volume: A Clue to the Etiology of Idiopathic Normal-Pressure Hydrocephalus?

William G. Bradleya, Francis G. Safara, Claudia Hurtadoa, Justin Orda and John F. Alksneb

a Department of Radiology, University of California, San Diego
b Department of Neurosurgery, University of California, San Diego



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  		FIG 1. Measurement of intracranial volume. Hyperintense CSF is outlined on T2-weighted images, and volume is calculated. Gaps have been interpolated to provide smooth surface contours.

A, Axial image.

B, Reformatted sagittal image.

C, Reformatted coronal image.



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  		FIG 2. Benign external hydrocephalus in 7-month-old infant results in enlargement of the frontal subarachnoid spaces with minimal ventricular enlargement.



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  		FIG 3. Chronically enlarged ventricles in a patient developing NPH.

A, At age 67 years, this patient had clearly enlarged ventricles. CT was performed to evaluate suspected giant cell arteritis. The patient was walking 20 miles a day and underwent successful shunt placement for NPH 19 years later.

B, At age 70, the patient still had no symptoms of NPH.

C–E, At age 76, the ventricles are markedly enlarged. Proton density–weighted image (C) shows a prominent CSF flow void in the aqueduct. The patient will not develop symptoms of NPH for another 10 years (when a pacemaker precluded MR imaging).





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X