Imaging

1. Computed Tomography

Computed tomography (CT) scanning will show ventricular enlargement and may also help determine the cause of hydrocephalus (e.g., tumors/cysts, congenital anomalies, or the presence of blood). Asymmetry of the ventricular system or the pattern of ventricular enlargement may also suggest the cause, as in aqueductal stenosis. Periventricular hypodensity may be present in some cases, suggesting extravasation of fluid into the periventricular space. Besides their role in diagnosis, CT scans are also essential for assessing response to treatment as well as follow-up.

2. Magnetic Resonance Imaging

Conventional magnetic resonance imaging (MRI) provides similar information as that of CT scanning about ventricular size, but MRI has a higher yield in identifying or characterizing associated or causative abnormalities. Special sequences are useful for identifying or quantifying flow through the aqueduct, for example, and making the diagnosis of aque-ductal stenosis as well as determining the efficacy of certain forms of treatment, such as endoscopic ventriculostomy.

3. Ultrasound

This imaging modality is practical only in infants who have a patent fontanelle. Its usefulness lies in its relative low cost (compared to CT and MRI) as well as its ease of application at the bedside or in restless infants. It is excellent at establishing ventricular size, symmetry, and even the cause of hydrocephalus (most commonly, intraventricular blood in this age group). It is also extremely useful for follow-up after treatment until the age of approximately 6 months, when the anterior fontanelle becomes too small.

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