case_images: PMC10865422_01
case_images: Three-dimensional reconstruction of T2-weighted MRI images of the ventricle.. (A) Anterior view. (B) Lateral (right) view. (C) Lateral (left) view. (D) Posterior view. White arrows indicate ventricular ruptures.
case_images: cureus-0016-00000052292-i01.jpg
case_images: PMC10865422_01_cureus-0016-00000052292-i01.jpg
case_images: FIG1
case_images: Three-dimensional reconstruction of MRI images of the ventricles showed a clear picture of massive ventriculomegaly with atypical wing-like structures that projected to the cortex from the superior aspect of both the right and left inferior horns of the lateral ventricle (Figure 1).
case_images: MRI images of the patient's head. . (A) T1-weighted sagittal view. (B) T2-weighted coronal view. (C) and (D) Fluid-attenuated inversion recovery (FLAIR) axial view. White arrows indicate spontaneous ventriculostomy, yellow arrows indicate the rupture of ventricular walls, and red arrows indicate remnants of the septum pellucidum.
case_images: cureus-0016-00000052292-i02.jpg
case_images: PMC10865422_01_cureus-0016-00000052292-i02.jpg
case_images: FIG2
case_images: Further investigation revealed a thinning of the cortex in the temporal lobes with suspected rupture of the ventricular walls that formed a circuit continuing to the subarachnoid space of the cortex (Figures 2C, 2D). Septum pellucidum was completely absent with small remnants of it seen in between the anterior horns of the lateral ventricle at the level of the genu of the corpus callosum (Figures 2B, 2C). Careful observation revealed a small spontaneous third ventriculostomy that connected the interpeduncular cistern to the floor of the third ventricle (Figure 2A).
case_images: Cine phase-contrast MRI images of the patient's head in sagittal view.. The pulsatile flow of cerebrospinal fluid (CSF) is shown in the images. (A) The cranial flow of CSF during diastole is demonstrated in black. (B) The caudal flow of CSF during systole is demonstrated in white. White arrows indicate the flow of CSF through spontaneous third ventriculostomy.
case_images: cureus-0016-00000052292-i03.jpg
case_images: PMC10865422_01_cureus-0016-00000052292-i03.jpg
case_images: FIG3
case_images: MRI showed a small CSF flow through the spontaneous third ventriculostomy, but no peak flow dynamics were observed in the cerebral aqueduct (Figure 3). Magnetic resonance (MR) angiogram showed no abnormalities in the anatomy and course of cerebral arteries and venous drainage system, except for the right vertebral artery, which was hypoplastic.