Original scientific paper
https://doi.org/10.3325/cmj.2014.55.394
Long lasting near-obstruction stenosis of mesencephalic aqueduct without development of hydrocephalus – case report
Milan Radoš
; Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia
Darko Orešković
; Department of Molecular Biology, Ruđer Bošković Institute, Zagreb, Croatia
Marko Radoš
; Department of Neurology, Clinical Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
Ivana Jurjević
; Department of Neurology, Clinical Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
Marijan Klarica
; Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia
Abstract
The aim of this study is to present the five-year longitudinal
magnetic resonance imaging (MRI) follow up of a patient
with incidental finding of near-obstruction stenosis
of the aqueduct of Sylvius due to a large pineal cyst. The
patient was scanned 3 times on a 3T MR device using a
set of standard structural sequences supplemented with
high-resolution constructive interference of steady state
(CISS) T2 sequence for precise delineation of the aqueduct
of Sylvius and cardiac-gated phase-contrast sequences for
the analysis of cerebrospinal fluid (CSF) movement. On all
MR scans, the size of the pineal cyst and severity of nearobstruction
aqueductal stenosis did not show any morphological
changes. There was no significant ventricular
enlargement although structural CISS sequence showed
a near-obstruction stenosis and cardiac-gated phase-contrast
sequences did not detect CSF movement through
the aqueduct of Sylvius. Our findings are contradictory to
the classic hypothesis of CSF physiology based on secretion,
circulation, and absorption of CSF, which states that
the impairment of CSF circulation through the aqueduct
of Sylvius inevitably leads to a hypertensive hydrocephalus
development involving the third and the lateral ventricle.
Our research group previously proposed a new hypothesis
of CSF physiology, which offers more suitable explanation
for such clinical cases.
Keywords
Hrčak ID:
129945
URI
Publication date:
15.8.2014.
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