[Clinical evaluation of an isolated fourth ventricle]

Since the introduction of the CT scan in 1976, we have experienced 6 cases of the isolated fourth ventricle among 244 hydrocephalic patients (2.5%). Age at diagnosis of the isolated fourth ventricle ranged from 1 year 8 months to 13 years (mean age, 8 years, 6 months). The time interval between the first shunting procedure and the diagnosis of the isolated fourth ventricle varied from 1 year 5 months to 7 years 4 months (mean interval, 4 years 1 months). The prior hydrocephalus were due to intraventricular hemorrhage in two patients, meningomyelocele in a patient and brain tumor in three patients. Two patients had history of cerebrospinal fluid (CSF) infection and five cases underwent multiple shunt revisions. Posterior fossa signs were evident in all cases. It was quite easy to make a diagnosis of the isolated fourth ventricle with CT scan, which demonstrated a large rounded or pear-shaped midline cyst in the posterior fossa. Slit-like lateral ventricles were noted in three cases, while the remaining three had enlarged lateral ventricles. Ventriculography confirmed the isolation of the fourth ventricle in 5 cases. Metrizamide which had been injected into the fourth ventricle was diluted when CT scan was performed 48 hours later, and contrast medium disappeared since then. Magnetic resonance imaging (MRI) well showed the characteristic findings of the isolated fourth ventricle: cystic dilatation of the fourth ventricle, compression and distortion of the brain stem, upward tentorial herniation, occlusion of the aqueduct, downward displacement of the occipital lobe, septum formation of the fourth ventricle and accompanied anomalies such as, Chiari malformation or syringomyelia.(ABSTRACT TRUNCATED AT 250 WORDS)