Imaging pearls to distinguish acute vs. chronic hydrocephalus

[neuromedstu]

Hello,

I often see acute hydro thrown into rads reports which I’m assuming is in contradistinction to chronic hydro. 

I haven’t been able to find much online in terms of radiographic features that would help you distinguish one versus the other

Any insights would be greatly appreciated!

[Guest]

(05-08-2021, 01:13 PM)neuromedstu Wrote: Hello,

I often see acute hydro thrown into rads reports which I’m assuming is in contradistinction to chronic hydro. 

I haven’t been able to find much online in terms of radiographic features that would help you distinguish one versus the other

Any insights would be greatly appreciated!

Obvious one is comparing prior HCT, always look over prior imaging. Transependymal flow, sulcal effacement and loss of gray/white matter differentiation is a good sign of high pressure. If someone has large vents but also has cortical atrophy and a ton of room between the cortex and skull then you can more confidently say its ex vacuo or at least not acute hydrocephalus.

[Guest]

hydrocephalus is a clinical diagnosis. ventriculomegaly is a radiographic finding. the clinical context and not the radiographic findings make the diagnosis of acute hydrocephalus vs ex vacuo ventriculomegaly.

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(05-09-2021, 10:07 AM)Guest Wrote: hydrocephalus is a clinical diagnosis. ventriculomegaly is a radiographic finding. the clinical context and not the radiographic findings make the diagnosis of acute hydrocephalus vs ex vacuo ventriculomegaly.

Agree with this. Easiest way to get burned as an intern/junior resident is missing shunt malfunction in a slit ventricular hydrocephalus kid.

[Guest]

(05-09-2021, 10:07 AM)Guest Wrote: hydrocephalus is a clinical diagnosis. ventriculomegaly is a radiographic finding. the clinical context and not the radiographic findings make the diagnosis of acute hydrocephalus vs ex vacuo ventriculomegaly.

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(05-09-2021, 10:07 AM)Guest Wrote: hydrocephalus is a clinical diagnosis. ventriculomegaly is a radiographic finding. the clinical context and not the radiographic findings make the diagnosis of acute hydrocephalus vs ex vacuo ventriculomegaly.

Agree with this. Easiest way to get burned as an intern/junior resident is missing shunt malfunction in a slit ventricular hydrocephalus kid.

Agree 100%. Its annoying when radiology is calling hydrocephalus on a read. Just call it what it is, ventriculomegaly. The best is when they are diagnosing NPH on a hct..