A Rare Cause of Obstructive Chronic Hydrocephalus in an Adult Patient: A Case Report of Fourth Ventricle's Foramina Idiopathic Stenosis

Background & Importance: Idiopathic stenosis of the foramina of Magendie and Luschka is a rare cause of obstructivehydrocephalus involving the fourth ventricle.Case Presentation: We reported the case of a 40-year-old woman who developed headaches and vertigo for several monthsand more recently gait disturbance. The CT scan showed quadri-ventricular hydrocephalus involving mainly the fourthventricle with dilated lateral recesses. Craniocervical MRI confirmed hydrocephalus and also showed the brainstem andcerebellar tonsil herniation through the foramen magnum with hydromyelia and a hyperintense signal on T2 weightedMRI of cervical spinal cord. Biological analyses were normal. She underwent endoscopic third ventriculostomy (ETV).No complication was observed. The patient became asymptomatic during the weeks following the surgical procedureand remained stable at a mean follow-up interval of 20 months. Postoperative MR images demonstrated regression of thehydrocephalus; complete disappearance of brainstem and cerebellar tonsil herniation, hydromylia and the hyperintensesignal on T2 weighted MRI of cervical spinal cord.Conclusion: This case confirms the existence of hydrocephalus caused by idiopathic fourth ventricle outflows obstructionin adult and the efficacy of ETV for this rare indication.

کلیدواژه ها:

Hydrocephalus ، V4 foramina stenosis ، ETV