MRI interpretation - NPH or hydrocephalus? Need to know how to proceed and what to expect.

[mascot1]

The lateral ventricles are moderately dilated. The third and fourth ventricles are mildly dilated. The right lateral ventricle is dilated greater than left. The sulci are prominent and ventricles are symmetrically dilated indicative of volume loss. Hyperintense T2 signal within the periventricular white matter is consistent with nonspecific white matter disease. The remaining brain signal intensity with its gray-white matter interface is normal. The midline structures are central. No diffusion restriction is present to suggest acute or subacute ischemia. Contrast fails to reveal abnormal enhancement.

Impression:   Hydrocephalus.

[mascot1]

Thank you.  I am new to this board and could not find an answer to my question originally.  This is a new diagnosis as a result of my ER visit due to my tripping over a box and banging my head very hard against a metal desk, sustaining a mild concussion.  The CT findings suggested ventriculomegaly and NPH and they wanted me to have the MRI which you just read.  I have a follow-up appt with a neurophysiologist in early January.  My background is in the medical field but I needed an interpretation on the MRI and was concerned more about plaque and the white matter disease for obvious reasons.

Thank you.  

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. It is also difficult to provide an adequate answer without the ability to look at the MRI myself. However I will try to provide you with some useful information.

The MRI read that you provide does suggest hydrocephalus. The cause of the hydrocephalus will need to be assessed. Hydrocephalus can be of various types: communicating (where CSF has a hard time being reabsorbed), noncommunicating (where CSF is being blocked by some lesion or product within the CSF space – they may be seen after patients have a hemorrhage for example), or ex vacuo (where CSF increase because of a decrease in brain matter i.e., atrophy).

If the ventricles look larger than would be expected and the patient has symptoms suggestive of NPH such as gait instability or urinary incontinence or change in behavior, this diagnosis may be higher on the differential.

A lumbar puncture may be necessary to sort out of the hydrocephalus if unable by history and MRI.

I suggest you have the MRI read by a local radiologist or neurologist with them knowing the history of the symptoms.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.