Alkhudari Anas,  Galal Maad,  Aljabr Aljoharah

Final Pr. ID: Poster #: CR-004

In the treatment of infant hydrocephalus, ventriculoperitoneal (VP) shunts are considered the standard of care. Various complications are associated with VP shunting. Ventriculoperitoneal shunt catheter migration remains a rare but documented complication seen in one in 1000 patients who receive a VP shunt. Migration of the VP shunt into the scrotum is even more uncommon and requires surgical treatment.

We report a unique case of a 6-month-old preterm male with history of hydrocephalus treated with surgically placed VP shunt. He presented with vomiting and was found to have a right inguinoscrotal sac swelling with the tip of the catheter appreciated upon palpation of the sac and later confirmed by abdominal radiograph. After admission, the patient started to show rapid and significant improvement without significant intervention. On further imaging, the positioning of the VP shunt improved with a sufficiently reduced tip highlighting the spontaneous reduction of the distal catheter tip. Repeated imaging months later showed no recurrence.

Scrotal migrations are more common in children, and this is commonly thought to be due to an unobliterated processus vaginalis allowing the catheter tip to enter the scrotal sac. As most patients remain asymptomatic and present only after an exacerbation with co-infections, the importance of early diagnosis should not be neglected. This is crucial to avoid subsequent complications such as acute hydrocephalus, testicular torsion, and peritoneal perforation. For nearly all scrotal VP shunt migration cases, definitive treatment is surgical with manual repositioning followed by hernia repair. VP shunt migration should remain an essential differential of scrotal masses in that patient population. We also want to raise awareness to radiologists about the malposition of the VP shunt catheter and the rare ability for it to reduce and retract into appropriate positioning spontaneously. We believe that these recommendations will help improve quality of care management in pediatric hydrocephalus patients. Read More

Authors:  Alkhudari Anas , Galal Maad , Aljabr Aljoharah

Keywords:  Hydrocephalus, Ventriculoperitoneal Shunt Migration, Scrotal Sac Swelling

Juang Eric,  Parikh Rajan,  Goncalves Luis,  Cornejo Patricia

Final Pr. ID: Poster #: EDU-027

Illustrate the spectrum of imaging findings of prenatal and postnatal diencephalic-mesencephalic junction dysplasia (DMJD). Read More

Authors:  Juang Eric , Parikh Rajan , Goncalves Luis , Cornejo Patricia

Keywords:  Fetal, hydrocephalus, L1CAM mutation

Holz Emily,  Fisher Paul

Final Pr. ID: Poster #: CR-050

Neurocysticercosis (NCC) is the result of infection of the nervous system by the larvae of Taenia solium—the pork tapeworm. It is endemic in regions of Latin America, Sub-Saharan Africa, and Asia, however, is also of concern in non-endemic regions as a result of immigration and travel to endemic regions. NCC is a major cause of seizures, however disease presentation varies based on the number, growth, and location of lesions as well as the inflammatory response of the host. In addition to seizures, other common clinical manifestations are headaches, intracranial hypertension, focal deficits, and altered mental status. Case Presentation: A 13-year old female with a history of intermittent headaches presented to the emergency department with severe headache, nausea and vomiting, and altered mental status. Upon evaluation, the patient had a Glasgow Coma Scale score of 8, indicative of a severe level of brain injury. A brain MRI revealed a non-enhancing “cystic” ovoid lesion filling much of the third ventricle. A subsequent CT revealed a scolex (anterior end of the tapeworm) with obstructive hydrocephalus at the level of the third ventricle and cerebral aqueduct. NCC has 3 stages—vesicular, colloidal or granular, and calcified—each with characteristic findings on imaging. In the vesicular stage, imaging shows cysts with central hyperdensity on CT representing the scolex. In the colloidal or granular stage, imaging shows cysts with surrounding enhancement and edema, and in the calcified stage, calcifications are visible. In this case, the patient appeared to be at the end of the vesicular stage, transitioning into the colloidal or granular stage as there was evidence of a scolex on CT and a cystic lesion with interstitial edema, however it was non-enhancing. Additionally, in NCC parenchymal lesions are most common, and with antiparasitic treatment, have a generally benign prognosis. Extraparenchymal disease, which includes ventricular cysts as seen in this patient, is less common and is not benign, often resulting in obstructive hydrocephalus, also evident in this patient, and may even result in death. Based on imaging findings, the patient underwent fenestration of the cyst and biopsy, which revealed fragments of a parasitic organism. NCC can result in life-threatening consequences including hydrocephalus, herniation, and edema, so while treatment generally consists of anti-inflammatory and antiparasitic medications, surgery may be indicated in some patients. Read More

Authors:  Holz Emily , Fisher Paul

Keywords:  Pediatric Neuroradiology, Hydrocephalus, Brain MRI

Vidal Lorenna,  Guimaraes Carolina

Final Pr. ID: Poster #: EDU-040

Cerebral aqueductal stenosis remains the most common cause of congenital and acquired obstructive hydrocephalus. The objective of this educational exhibit is to interactively illustrate the imaging findings associated with aqueductal stenosis on Fetal and postnatal MRI. Causes of aqueductal stenosis and imaging protocol optimization will also be discussed.
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Authors:  Vidal Lorenna , Guimaraes Carolina

Keywords:  Aqueductal stenosis, hydrocephalus, fetal MRI

Hoodeshenas Safa,  Averill Lauren,  Mody Tejal,  Johnson Craig

Final Pr. ID: Poster #: EDU-079

CSF shunts play a vital role in diverting excess cerebrospinal fluid to other body compartments, thereby preventing potentially life-threatening complications. This presentation aims to provide a comprehensive overview of CSF shunt systems and their evaluation using multimodal imaging techniques.
We will briefly review the various types of CSF shunts and their essential components. The discussion will also cover imaging protocols and MRI safety considerations for patients with shunts, with a focus on what clinicians need to see in imaging reports.
Additionally, special emphasis will be placed on shunt-related complications, such as shunt malfunctions (e.g., disconnections, migration, leakage and overdrainage); over-shunting myelopathy (Miyazaki syndrome); slit ventricle syndrome; trapped ventricle; infections (ventriculitis, meningitis); and distal catheter complications (e.g., peritoneal CSF pseudocysts with and without infection, peritonitis, pleural effusions). Read More

Authors:  Hoodeshenas Safa , Averill Lauren , Mody Tejal , Johnson Craig

Keywords:  Shunts, CSF, Hydrocephalus

Freiling John,  Desai Nilesh,  Whitehead William,  Kralik Stephen,  Huisman Thierry

Final Pr. ID: Poster #: SCI-028

The purpose of this study was to determine if concavity of the basiocciput and concavity of the posterior atlanto-occipital membrane are correlated with the need for future hydrocephalus surgical intervention. Read More

Authors:  Freiling John , Desai Nilesh , Whitehead William , Kralik Stephen , Huisman Thierry

Keywords:  Chiari II, Hydrocephalus