Isolated Fourth Ventricle Causes a Mass Effect in the Posterior Fossa. Difficulties of Making a Diagnosis in the Intensive Care Unit in Comatose Patients: Clinical Overview

Jarosław Andrychowski, Lidia Glinka, Nastazja Karakina and Dagmara Szymkowicz-Kudełko

Department of Neurology, Neurological Rehabilitation and Kinesytherapy, The Institute of Physiotherapy, The Faculty of Medicine and Health Sciences, University Jan Kochanowski, Kielce, Poland
Department of Neurotraumatology, Medical University of Warsaw, Poland
Department of Anesthesiology and Intensive Care, University of Warmia and Mazury in Olsztyn, Poland
Department of Neurosurgery, The Children's Memorial Health Institute, Warsaw, Poland

^*Correspondance to: Jaros?aw Andrychowski 

 PDF  Full Text DOI: 10.25107/2474-1647.2148

Abstract

Isolated fourth ventricle (IFV) is a rare radiological and clinical complication of the surgical treatment within the cerebral fluid pathways. It may occur as a result of a neurosurgical procedure when post resection space communicates with the fourth ventricle, be a complication of shunt therapy, external drainage or endoscopy of the ventricular system. Neuroinfection or subarachnoid hemorrhage can predispose to the development of the syndrome. The pathomechanism is associated with disturbances in the patency of the Sylvian aqueduct and the outflow routes from the fourth ventricle. An important role in pathology is attributed to the vascular plexus of the fourth ventricle and its physiological secretion of cerebrospinal fluid. The resulting IFV reservoir causes a mass effect in the posterior fossa and the development of compression symptoms in the brainstem. Imaging tests reveal the signs of retention of the cerebrospinal fluid (CSF) inside the surrounding white matter of the posterior fossa. This causes deterioration of the clinical state which is dependent on the compression on the brainstem. At the same time, the supratentorial space of the brain is effectively treated with ventricular drainage or using a shunt. Previous publications mainly concentrated on pediatric patients. In adult patients, IFV is a rare complication that develops few months after the first surgical procedure. The mass effect increases consciousness disorders and brainstem symptoms. We present the diagnosis of IFV in a patient who was unconscious and subjected to long-term hospitalization in the ICU. We pointed out the importance of a detailed examination of brainstem symptoms and the necessity to perform the sequence of MRI images with the cine option after specific neurosurgical procedures. Some neurosurgical procedures may predispose to the development of IFV.

Keywords

Fourth ventricle; Posterior fossa; Isolated ventricle; Complication; Ventriculostomy; Shunt therapy; Intensive care unit

Cite the article

Andrychowski J, Glinka L, Karakina N, Szymkowicz-Kude?ko D. Isolated Fourth Ventricle Causes a Mass Effect in the Posterior Fossa. Difficulties of Making a Diagnosis in the Intensive Care Unit in Comatose Patients: Clinical Overview. Clin Surg. 2018; 3: 2148.