Clinical Presentation

A 12-year-old boy with progressive headaches.

(A) Sagittal T1-weighted image (WI) shows noncommunicating hydrocephalus with dilated lateral and 3rd ventricles (asterisks). The 4th ventricle is not dilated (arrow), and the anatomy of the tectum is distorted (arrowhead). (B) Axial fluid-attenuated inversion recovery (FLAIR) image shows hyperintensity in the midbrain (arrow). The lateral and 3rd ventricles are dilated (asterisks). (C) Axial T1WI with contrast shows no enhancement in the midbrain (arrow). Hydrocephalus is seen (asterisks). (D) Axial FLAIR image shows normal size of the lateral ventricles (asterisks) after decompression through a shunt. The area of hyperintensity in the midbrain is again seen (arrow).

Differential Diagnosis