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IMAGES IN NEUROLOGY
Year : 2010  |  Volume : 13  |  Issue : 4  |  Page : 311-312
 

Every non-obstructive hydrocephalus is not due to tuberculous basal meningitis


Himalayan Institute, Swami Ram Nagar, Doiwala, Dehradun, India

Date of Submission08-Feb-2010
Date of Decision09-Dec-2010
Date of Acceptance16-Jun-2010
Date of Web Publication24-Dec-2010

Correspondence Address:
Deepak Goel
Neurology Department, Himalayan Institute, Swami Ram Nagar, Doiwala, Dehradun - 248 140
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-2327.74191

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How to cite this article:
Goel D, Bansal K K, Mittal M, Ranjeet. Every non-obstructive hydrocephalus is not due to tuberculous basal meningitis. Ann Indian Acad Neurol 2010;13:311-2

How to cite this URL:
Goel D, Bansal K K, Mittal M, Ranjeet. Every non-obstructive hydrocephalus is not due to tuberculous basal meningitis. Ann Indian Acad Neurol [serial online] 2010 [cited 2019 Oct 22];13:311-2. Available from: http://www.annalsofian.org/text.asp?2010/13/4/311/74191



   Introduction Top


A 42 year male presented with episodic headache and vomiting. Two years earlier he had similar symptoms when a diagnosis of tuberculous meningitis was made after CSF examination. He was treated with antitubercular drugs and a ventriculoperitoneal shunt was placed with good relief. One year later he had recurrence of headache when second scan showed persistent of hydrocephalus [Figure 1]. Considering a shunt failure, a shunt revision surgery was done without much relief . We proceeded to carry out an endoscopic third ventriculostomy (ETV) To our surprise, after third ventriculostomy as the endoscope was negotiated into aqueduct, two grapes like structures were visualized that were attached to the floor of 4th ventricle [Figure 2]. En-block removal of the cysts could be done and diagnosis of neurocysticercosis (NCC) was confirmed.
Figure 1: T1W sagittal MRI showing no obvious obstruction

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Figure 2: Endoscopic view showing two cysticerci in 4th ventricle

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In India, both NCC and tuberculosis of central nervous system (CNS) are common endemic problems. Obstructive hydrocephalus by CNS tuberculosis is common, [1] but hydrocephalus due to intraventricular NCC is reported in case series or case reports only. [2] One author reported that intraventricular NCC constitutes only 7-20% of all cases affected by this infestation. [3]

It is important to consider that hydrocephalus in the absence of obvious obstruction might not be due to CNS tuberculosis. New imaging such as three-dimensional constructive interference in steady state (3D-CISS) or heavily T2W sequences could improve the diagnosis. [4] In cases where hydrocephalus is acute in the onset and tubercular toxemia is absent, ETV is better choice. Moreover, in cases of shunt failure, ETV can be a better choice than revision of shunt. [3]

 
   References Top

1.Jonathan A, Rajshekhar V. Endoscopic third ventriculostomy for chronic hydrocephalus after tuberculous meningitis. Surg Neurol 2005;63:32-5.  Back to cited text no. 1
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2.Husain M, Jha DK, Rastogi M, Husain N, Gupta RK. Neuro-endoscopic management of intraventricular neurocysticercosis (NCC). Acta Neurochirurgica 2007;149:341-6.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Govindappa SS, Narayanan JP, Krishnamoorthy VM, Shastry CH, Balasubramanium A, Krishna SS. Improved Detection of Intraventricular Cysticercal cysts with the Use of Three ­dimensional Constructive Interference in Steady State MR Sequence. AJNR Am J Neuroradiol 2000;21:679-84.  Back to cited text no. 3
    
4.Kurihara N, Takahashi S, Tamura H, Higano S, Furuta S, Jokura H, et al. Investigation of hydrocephalus with three-dimensional constructive interference in steady state MRI. Neuroradiology 2000;42:634-8  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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