1-This radiological appearance could be seen in two conditions
2-The first one is due to non communicating obstructive hydrocephalus with obstruction at the level of outlet foramina of the fourth ventricle.
3-The second one is due to communicating obstructive hydrocephalus.
4-You can differentiate between two entities by looking for type of dilatation of the fourth ventricle.
5-If the fourth ventricle is ballooned, this suggests the former, while if it is dilated without ballooning appearance, this suggests the latter.
6-Causes of fourth ventricle hydrocephalus:
-Congenital: Atresia of the outlet foramina.
-Inflammatory as in encephalitis.
-Neoplastic:
*In child as medulloblastoma, astrocytoma and brain stem glioma.
*In Adult as ependymoma, metastases and hemangioblastoma.
*Cerebello-pontine angle masses such as meningioma and acoustic neuroma.
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