CASE 6

Courtesy of Almoosa Specialist Hospital

10-years-old male with ventriculoperitoneal shunt

{"items":["a79045_064bd84fe8b54534af58fbae5439dbd9~mv2.jpeg","a79045_8d92f444140e4bcc8ebaa991f5721ad4~mv2.jpeg","a79045_9842c22bbd1e431fb2f01db1f8b15017~mv2.jpeg","a79045_a2091e3412cb46c7bad51924db5ff6d1~mv2.jpeg"],"styles":{"galleryType":"Columns","groupSize":1,"showArrows":false,"cubeImages":true,"cubeType":"fill","cubeRatio":1,"isVertical":true,"gallerySize":300,"collageAmount":0,"collageDensity":0,"groupTypes":"1","oneRow":false,"imageMargin":2,"galleryMargin":0,"floatingImages":0,"chooseBestGroup":true,"smartCrop":false,"hasThumbnails":false,"enableScroll":true,"isGrid":true,"isSlider":false,"isColumns":false,"isSlideshow":false,"cropOnlyFill":false,"fixedColumns":4,"enableInfiniteScroll":1,"isRTL":false,"minItemSize":50,"rotatingGroupTypes":"","rotatingCubeRatio":"","gallerySliderImageRatio":1.7777777777777777,"numberOfImagesPerRow":4,"numberOfImagesPerCol":1,"groupsPerStrip":0,"borderRadius":0,"boxShadow":0,"gridStyle":1,"mobilePanorama":false,"placeGroupsLtr":false,"viewMode":"preview","thumbnailSpacings":0,"galleryThumbnailsAlignment":"none","isMasonry":false,"isAutoSlideshow":false,"slideshowLoop":false,"autoSlideshowInterval":4,"useCustomButton":false,"bottomInfoHeight":0,"titlePlacement":"SHOW_ON_HOVER","galleryHorizontalAlign":"center","galleryTextAlign":"center","galleryVerticalAlign":"center","scrollSnap":false,"itemClick":"link","fullscreen":false,"allowSocial":false,"allowDownload":false,"allowTitle":true,"allowDescription":false,"loveButton":false,"loveCounter":false,"videoPlay":"onClick","scrollAnimation":"NO_EFFECT","scrollDirection":0,"overlayAnimation":"NO_EFFECT","arrowsPosition":0,"arrowsSize":23,"watermarkOpacity":40,"watermarkSize":40,"useWatermark":true,"watermarkDock":{"top":"auto","left":"auto","right":0,"bottom":0,"transform":"translate3d(0,0,0)"},"loadMoreAmount":"all","defaultShowInfoExpand":1,"allowTitleExpand":true,"allowDescriptionExpand":true,"allowLinkExpand":true,"expandInfoPosition":0,"allowFullscreenExpand":true,"fullscreenLoop":false,"galleryAlignExpand":"left","addToCartBorderWidth":1,"addToCartButtonText":"","slideshowInfoSize":200,"playButtonForAutoSlideShow":false,"allowSlideshowCounter":false,"hoveringBehaviour":"APPEARS","thumbnailSize":120,"magicLayoutSeed":1,"imageHoverAnimation":"NO_EFFECT","calculateTextBoxHeightMode":"AUTOMATIC","calculateTextBoxWidthMode":"PERCENT","textBoxHeight":0,"textBoxWidth":200,"textBoxWidthPercent":50,"textImageSpace":10,"textBoxBorderRadius":0,"textBoxBorderWidth":0,"textsVerticalPadding":0,"textsHorizontalPadding":0,"titleDescriptionSpace":6,"customButtonText":"","customButtonBorderWidth":1,"customButtonBorderRadius":0,"loadMoreButtonText":"","loadMoreButtonBorderWidth":1,"loadMoreButtonBorderRadius":0,"imageInfoType":"NO_BACKGROUND","itemBorderWidth":0,"itemBorderRadius":0,"itemEnableShadow":false,"itemShadowBlur":20,"itemShadowDirection":135,"itemShadowSize":10,"imageLoadingMode":"BLUR","expandAnimation":"NO_EFFECT","imageQuality":90,"usmToggle":false,"usm_a":0,"usm_r":0,"usm_t":0,"videoSound":false,"videoSpeed":"1","videoLoop":true,"galleryLayout":2,"gallerySizeType":"px","gallerySizePx":300,"allowHover":true,"mobileSwipeAnimation":"NO_EFFECT","gotStyleParams":true,"showVideoPlayButton":true,"imageResize":false,"galleryImageRatio":2,"modifiedGallerySize":true,"selectedLayout":"2|none|1|fill|true|0|1","layoutsVersion":2,"selectedLayoutV2":2,"isSlideshowFont":false,"externalInfoHeight":0,"externalInfoWidth":0},"container":{"galleryWidth":2564,"galleryHeight":1440,"scrollBase":0,"height":null,"width":null}}

---

CASE 6 ANSWER

Dandy-Walker Malformation

{"items":["a79045_20baf324fcb34660ac337926cfd2c4cf~mv2.png","a79045_a86991517242466aba5c3ba65092ecd1~mv2.png","a79045_4de61d1d55204bcf974aff18d93a4d4d~mv2.png","a79045_d33400f1281d49f5be814eb5384e031a~mv2.png"],"styles":{"galleryType":"Columns","groupSize":1,"showArrows":false,"cubeImages":true,"cubeType":"fill","cubeRatio":1,"isVertical":true,"gallerySize":300,"collageAmount":0,"collageDensity":0,"groupTypes":"1","oneRow":false,"imageMargin":0.5,"galleryMargin":0,"floatingImages":0,"chooseBestGroup":true,"smartCrop":false,"hasThumbnails":false,"enableScroll":true,"isGrid":true,"isSlider":false,"isColumns":false,"isSlideshow":false,"cropOnlyFill":false,"fixedColumns":4,"enableInfiniteScroll":1,"isRTL":false,"minItemSize":50,"rotatingGroupTypes":"","rotatingCubeRatio":"","gallerySliderImageRatio":0,"numberOfImagesPerRow":4,"numberOfImagesPerCol":1,"groupsPerStrip":0,"borderRadius":0,"boxShadow":0,"gridStyle":1,"mobilePanorama":false,"placeGroupsLtr":false,"viewMode":"preview","thumbnailSpacings":0,"galleryThumbnailsAlignment":"none","isMasonry":false,"isAutoSlideshow":false,"slideshowLoop":false,"autoSlideshowInterval":4,"useCustomButton":false,"bottomInfoHeight":0,"titlePlacement":"SHOW_ON_HOVER","galleryHorizontalAlign":"center","galleryTextAlign":"center","galleryVerticalAlign":"center","scrollSnap":false,"itemClick":"link","fullscreen":false,"allowSocial":false,"allowDownload":false,"allowTitle":true,"allowDescription":false,"loveButton":false,"loveCounter":false,"videoPlay":"onClick","scrollAnimation":"NO_EFFECT","scrollDirection":0,"overlayAnimation":"NO_EFFECT","arrowsPosition":0,"arrowsSize":23,"watermarkOpacity":40,"watermarkSize":40,"useWatermark":true,"watermarkDock":{"top":"auto","left":"auto","right":0,"bottom":0,"transform":"translate3d(0,0,0)"},"loadMoreAmount":"all","defaultShowInfoExpand":1,"allowTitleExpand":true,"allowDescriptionExpand":true,"allowLinkExpand":true,"expandInfoPosition":0,"allowFullscreenExpand":true,"fullscreenLoop":false,"galleryAlignExpand":"left","addToCartBorderWidth":1,"addToCartButtonText":"","slideshowInfoSize":200,"playButtonForAutoSlideShow":false,"allowSlideshowCounter":false,"hoveringBehaviour":"APPEARS","thumbnailSize":120,"magicLayoutSeed":1,"imageHoverAnimation":"NO_EFFECT","calculateTextBoxHeightMode":"AUTOMATIC","calculateTextBoxWidthMode":"PERCENT","textBoxHeight":0,"textBoxWidth":200,"textBoxWidthPercent":50,"textImageSpace":10,"textBoxBorderRadius":0,"textBoxBorderWidth":0,"textsVerticalPadding":0,"textsHorizontalPadding":0,"titleDescriptionSpace":6,"customButtonText":"","customButtonBorderWidth":1,"customButtonBorderRadius":0,"loadMoreButtonText":"","loadMoreButtonBorderWidth":1,"loadMoreButtonBorderRadius":0,"imageInfoType":"NO_BACKGROUND","itemBorderWidth":0,"itemBorderRadius":0,"itemEnableShadow":false,"itemShadowBlur":20,"itemShadowDirection":135,"itemShadowSize":10,"imageLoadingMode":"BLUR","expandAnimation":"NO_EFFECT","imageQuality":90,"usmToggle":false,"usm_a":0,"usm_r":0,"usm_t":0,"videoSound":false,"videoSpeed":"1","videoLoop":true,"galleryLayout":2,"gallerySizeType":"px","gallerySizePx":300,"allowHover":true,"mobileSwipeAnimation":"NO_EFFECT","gotStyleParams":true,"showVideoPlayButton":true,"imageResize":false,"galleryImageRatio":2,"modifiedGallerySize":true,"selectedLayout":"2|none|1|fill|true|0|1","layoutsVersion":2,"selectedLayoutV2":2,"isSlideshowFont":false,"externalInfoHeight":0,"externalInfoWidth":0},"container":{"galleryWidth":2561,"galleryHeight":1440,"scrollBase":0,"height":null,"width":null}}

A large simple cyst (yellow arrows) communicates with a dilated 4th ventricle (yellow star), expands the posterior fossa, leads to superior rotation of a hypoplastic vermis (green arrow), anteriorly displaces a flattened brain stem (red arrow), and causes obstructive hydrocephalus (white arrows). Note the presence of a ventriculoperitoneal shunt (black arrow).

Key Points

• The classic form manifests as a posterior fossa cyst communicating with a dilated fourth ventricle and leading to the superior rotation of a hypoplastic vermis, elevation of the torcular herophili, scalloping of the occipital bone.

• Hydrocephalus is a typical early manifestation.

• Commonly associated with other syndromic and non-syndromic features, such as cortical dysplasia, corpus callosum malformations, and other findings.