Normal Ventricular System Research Articles

Cephalometric Assessment of the Brain Ventricular System Index Using Computerised Tomography in Sokoto North-Western, Nigeria

Aim: To determine the normal brain ventricular system index of Nigerians using computerized tomography in Sokoto North-Western Nigeria.
 Study Design: Retrospective cross- sectional.
 Place and Duration of Study: Department of Anatomy Usmanu Danfodiyo University Sokoto and Department of Radiology Usmanu Danfodiyo University Teaching Hospital Sokoto, between January, 2020 and January, 2022.
 Methodology: One hundred and seventy-eight normal brain CT scans of subjects from the Radiology Department, whose ages ranged from 1 to 70 years, were recruited for this study.
 The Bi-frontal and Bi-occipital indices were calculated as ratios of measured distances of the frontal and occipital horns of the lateral ventricles and the transverse intracranial diameter, at the same level, respectively. The brain ventricular system index was then determined by a ratio of the Bi-frontal index and Bi-occipital index.
 Results: The largest brain ventricular system indexes were 7.83cm and 7.68cm in males and females respectively and these were observed between the age of 2-4years for both sexes. While, the smallest brain ventricular system indexes were 7.47cm in males and 7.29cm in females, which were observed in age group 61-70years for both sexes.
 Conclusion: This study was conducted to determine the Ventricular Brain System Index and it relation with sex and age in our environment.

Progressive supranuclear palsy with marked ventricular dilatation mimicking normal pressure hydrocephalus.

Progressive supranuclear palsy (PSP) patients can show ventricular enlargement mimicking normal pressure hydrocephalus (NPH). The aim of this study was to distinguish PSP patients with marked ventricular dilatation (PSP-vd) from those with normal ventricular system and to evaluate the coexistence of NPH in PSP-vd patients. One hundred three probable PSP patients, 18 definite NPH patients, and 41 control subjects were enrolled in the study. Evans index (EI) > 0.32 associated with callosal angle (CA) < 100° was used to identify PSP-vd patients. Automated ventricular volumetry (AVV) and Magnetic Resonance Hydrocephalic Index (MRHI) were performed on T1-weighted MR images to evaluate the presence of NPH in PSP-vd patients. Twelve (11.6%) out of 103 PSP patients had both abnormal EI and CA values (PSP-vd). In two of these 12 patients, AVV and MRHI values suggested PSP + NPH. In the remaining 10 PSP-vd patients, AVV and MRHI values were higher than PSP patients with normal ventricular system and controls, but lower than PSP + NPH and NPH patients, suggesting a non-hydrocephalic ventricular enlargement. Our study provides evidence that the combination of EI and CA biomarkers allowed to identify PSP patients with marked ventricular dilatation mimicking NPH. Only a few of these patients had PSP + NPH. Recognition of these PSP patients with enlarged ventricles can positively impact the care of this disease, helping clinicians to identify patients with PSP + NPH who could benefit from shunt procedure and avoid surgery in those with enlarged ventricles without NPH.

Corticospinal tract abnormalities and ventricular dilatation: A transdiagnostic comparative tractography study

BackgroundMicrostructural alterations of corticospinal tract (CST) have been found in idiopathic normal pressure hydrocephalus (iNPH). No study, however, investigated the effect of ventricular dilatation on CST in Progressive Supranuclear Palsy (PSP). ObjectiveThe aim of this study was to investigate CST diffusion profile in a large cohort of PSP patients with and without ventricular dilatation. MethodsTwenty-three iNPH patients, 87 PSP patients and 26 controls were enrolled. Evans index (EI) and ventricular volume (VV) were measured in all patients. CST tractography was performed to calculate FA, MD, AxD and RD in six different anatomical regions: medulla oblungata (MO), pons (P), cerebral peduncle (CP), posterior limb of internal capsule (PLIC), corona radiata (CR), subcortical white matter (SWM). ANCOVA was used for comparing CST diffusion profiles between the groups and association between CST microstructural metrics and measures of ventricular dilatation (EI and VV) was assessed. ResultsThirty-three PSP patients had ventricular dilatation (EI > 0.30, PSP-vd) while 54 PSP patients had normal ventricular system (EI ≤ 0.30, PSP-wvd). iNPH patients had the most marked FA and AxD increase in PLIC and CR of CST followed by PSP-vd, PSP-wvd and controls; RD was altered only in iNPH. A strong correlation was found between CST diffusion metrics and EI or VV. ConclusionsOur findings confirm the microstructural changes of CST in iNPH patients and demonstrate for the first time similar alterations in PSP-vd patients, suggesting a crucial role of ventricular dilatation in the mechanical compression of CST.

Disproportionately large communicating fourth ventricle: two case reports

BackgroundManagement of the disproportionately large communicating fourth ventricle is still problematic.Case presentationTwo cases of disproportionately large communicating fourth ventricle were treated successfully. One was a case of a 51-year-old Han Chinese woman with a complaint of headache and dizziness of 1 year’s duration. Magnetic resonance imaging (MRI) demonstrated hydrocephalus with a disproportionately large fourth ventricle. She underwent a ventriculo-peritoneal shunt of the right lateral ventricle. Her symptoms were relieved totally. Five years later, magnetic resonance imaging showed she had a normal ventricular system. The other case was a 24-year-old Han Chinese man with a 2-month history of headache and dizziness accompanied by progressive loss of bilateral vision. Magnetic resonance imaging revealed hydrocephalus with a disproportionately large fourth ventricle, crowded posterior cranial fossa, and syringomyelia extending from C1 to C5. He underwent suboccipital and C1 decompression and duraplasty. Shortly after the surgery, his symptoms were relieved completely, the syringomyelia completely disappeared, and the fourth ventricle became significantly smaller.ConclusionsThe management of the disproportionately large communicating fourth ventricle should be individualized. If it coexists with crowded posterior cranial fossa or syringomyelia, posterior fossa decompression could be an option for initial management. If there is no sign of crowded posterior cranial fossa or syringomyelia, shunt of the lateral ventricles might be the first choice.

In normal aging ventricular system never attains pathological values of Evans' index.

Ventricular enlargement in normal aging frequently forces the radiological diagnosis of hydrocephalus, but the reliability of Evans' index as a radiological marker of abnormal ventricular enlargement (values > 0.30) during aging is not assessed. Here we analyze ventricular size during aging and the reliability of Evans' index as a radiological marker of abnormal ventricular enlargement. We calculated Evans' index in the axial Computed Tomography scans of 1221 consecutive individuals (aged 45-101 years) from an emergency department. Stratified analysis of one-year cohorts showed that the mean Evans' index value per class was invariably < 0.30. Roughly one out five Computed Tomography scans was associated with Evans' index values > 0.30 and Evans' index values increased with age. The risk of having an Evans' index value > 0.30 increased by 7.8% per year of age (p < 0.001) and males were at 83.9% greater risk than females (p < 0.001). Overall, this study shows that normal aging enlarges the ventricular system, but never causes abnormal ventricular enlargement. Evans' index values > 0.30 should reflect an underlying neurological condition in every individual.

Morphometric Analysis of the Brain Ventricles in Normal Subjects Using Computerized Tomography

Background and Aim: As ageing advances, the human brain undergoes many gross and histopathological changes with regression of the brain tissue leading to the enlargement of the ventricles. Knowledge of morphometric and size of normal ventricular system of brain is important to understand these changes. Methods: For the present perspective study, computerized tomography (CT) for 152 patients (Male-89 and Females-63) were studied for the measurements of fourth ventricle, third ventricle and lateral ventricle and it was statistically analyzed. Results: The anteroposterior extent of the body of the lateral ventricles on the right side was 74.89 + 9.86 mm and 70.06 + 8.83 mm in the males and females and on the left side was 74.89 + 9.89 mm and 69.56 + 11.42 mm in the males and females; the length of the frontal horns on the right side was 28.53 + 3.88 mm and 26.16 + 4.21 mm in the males and females and on the left side was 28.53 + 3.88mm and 26.17 + 4.237 mm in the males and females respectively. The width and height of the fourth ventricle were 12.54 + 1.90 mm and 9.66 + 2.12 in the males and 11.60 + 2.099 mm and 9.70 + 2.219 in the females respectively. The width of the third ventricle was 5.70 + 1.54 mm and 5.40 + 1.68 mm in the males and females respectively. Conclusion: The present study has defined the morphometric measurements of the lateral ventricles, third ventricle, and fourth ventricle of the brain which has clinical correlations in diagnosis and for further line of treatment.

Detection of the development of late-onset idiopathic aqueductal stenosis (LIAS) by chronological magnetic resonance imaging: a case report

Late-onset idiopathic aqueductal stenosis (LIAS) has been recognized as one of the clinical entities of adulthood hydrocephalus for decades, although there have been no radiological reports that show normal ventricular systems before the development of LIAS. We present here an adolescent case of LIAS with a previously normal ventricular system on magnetic resonance imaging (MRI). A 17-year-old boy had been suffering from chronic headaches and mild intellectual disability (MID) since he became a teenager, and this had prevented him from leading an ordinary school life. MRIs on admission showed triventriculomegaly from the aqueductal stenosis that had not been detected on previous MRIs, at least until the age of 6. An endoscopic third ventriculostomy was successfully performed, which improved both the headache and the MID. The developmental mechanism of LIAS remains unclear, although the membranous ependymal-like tissue observed in the aqueduct suggested the preceding existence of an inflammatory process around this region. To the best of our knowledge, this case was noteworthy because the development of LIAS was clearly demonstrated on MRI for the first time.

Ventricles of brain: A morphometric study by computerized tomography

Introduction: As the human brain ages, characteristic structural changes occur that are considered to be normal and are expected. Thus the thorough knowledge of the age related normal changes that occur in the brain is required before any abnormal findings are analyzed. As ageing advances, the brain undergoes many gross and histopathological changes with regression of the brain tissue leading to the enlargement of the ventricles. To understand these changes the knowledge of normal morphometry and size of normal ventricular system of brain is important. Materials & Methods: For the present study 358 (Males - 207 and Females - 151) individuals Computerized Tomography (CT) images of brain studied. Measurements of fourth ventricle, third ventricle and lateral ventricle were noted down from CT images and it was statistically analyzed. Results: After analysis it was observed that the height and width of the fourth ventricle was larger in males as compared to females. The length of the third ventricle was observed to be greater in females than in males. The width of the third ventricle it was observed to be greater in males than in females. Antero-posterior extent of the left frontal horn (males = 26.26 ± 2.94, 95% CI 25.86 - 26.66 mm and females = 26.53 ± 3.38, 95% CI 25.99 - 27.08 mm) was greater than that of the right ones (males = 25.00 ± 3.18, 95% CI 24.57 - 25.44 mm and females = 25.34 ± 3.50, 95% CI 24.78 - 25.90 mm). Conclusion: Advances in sensitive imaging techniques like the Computerized Tomography helps in dramatic expansion of our understanding of the normal structure of brain. The present study has defined the morphometric measurements of the lateral ventricles, third ventricle, and fourth ventricle of the brain which has clinical correlations in diagnosis and for further line of treatment.

Successful Treatment of Dandy–Walker Syndrome by Endoscopic Third Ventriculostomy in a 6-Month-Old Girl With Progressive Hydrocephalus: A Case Report and Literature Review

Dandy-Walker syndrome (DWS) is a congenital brain malformation involving the cerebellum and fourth ventricle. We report a 6-month-old girl with DWS presenting an initially normal ventricular system and mild cyst-like lesion over the posterior fossa as assessed by postnatal brain sonography. However, symptoms and signs of increased intracranial cerebral pressure in terms of frequent vomiting and tense anterior fontanel developed, and these were associated with mild hypotonia and poor neck support, and upward-gaze palsy at the age of 6 months. Magnetic resonance imaging revealed a huge cystic lesion of the fourth ventricle, which filled the posterior fossa and ventricular dilatation. The tentorium was progressively displaced upward by the cyst. A nearly complete agenesis of the cerebellar vermis was also confirmed. After a successful endoscopic third ventriculostomy, a series of brain magnetic resonance imaging scans, taken during a follow-up survey, showed normal lateral and third ventricles. Consequently, symptoms of intracranial cerebral pressure resolved, and a developmental milestone was achieved. In conclusion, DWS can be confirmed postpartum, and endoscopic third ventriculostomy was found to be a preferential operative procedure for DWS with hydrocephalus. It may be effective for patients younger than 1 year.

Spontaneous resorption of a sacral meningocele

Meningoceles are thought to be the products of postneurulation disorder. The neural tube is normally formed beneath the cutaneous lesion; however, when the subsequent development of the overlying mesenchymal tissues and cutaneous ectoderm are aberrant, the result is a cutaneous and mesenchymal defect that contains only cerebrospinal fluid (CSF). Chiari malformation Type II and hydrocephalus are not associated with meningoceles.1 They are important because of concomitant tethered cord, the chance of CSF leakage, discomfort and pain, their large size, and cosmetic aspects. Skin-covered lesions are managed in an elective manner when CSF leakage is not present. Meningoceles often increase in size. A girl born via cesarean section at term to a 24-year-old Gravida 1 mother was noted to have a large, skin-covered, soft-tissue mass protruding from her sacral region in the dorsal midline. Prenatal ultrasonography performed 1 month before delivery had revealed a large sacral meningocele, 7 cm in diameter without other abnormalities. The infant had no obvious neurological deficits. Spinal magnetic resonance (MR) imaging revealed a sacral meningocele, which seemed to be devoid of neural elements (Fig. 1). Its greater diameter was only 5.5 cm, smaller than the lesion observed on prenatal ultrasonography. We performed a complete urological evaluation that confirmed a normal urological state. Brain ultrasonography performed during the neonatal period had shown a normal ventricular system. Because of the normal skin covering the lesion, the lack of a tethered cord, and the progressive reduction in size, the girl was observed and did not undergo surgery. At 3 months of age, no obvious mass could be discerned on her back; only wrinkled skin was visible (Fig. 1 upper right). The second MR image obtained at 6 months of age demonstrated that the meningocele sac had disappeared (Fig. 1 lower right). A comprehensive Medline search of articles from 1966 to March 2004 revealed no previous cases of spontaneous regression of a meningocele. In some circumstances, meningoceles resolve after ventriculoperitoneal shunting or CSF diversion. 2,3 Restoration of normal CSF dynamics can reduce flow into the sac, resulting in meningocele size reduction. In our patient, the large meningocele sac (which was in direct communication with the spinal subarachnoid space) underwent a gradual size reduction perinatally that permitted us to observe the lesion only. We presume that this process of reduction is caused by a gradual obliteration of the dural defect or stalk (in which the communication disappears by thickening and adhesion of the leptomeninges at the orifice and by subsequent CSF resorption). High CSF pressure causes the sac to act as an additional fluid space that reduces the chance of spontaneous sac reduction. The absence of hydrocephalus in our patient may be another important factor that helped the resorption process.

Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)

Neurology| October 01 2001 Idiopathic Intracranial Hypertension (Pseudotumor Cerebri) AAP Grand Rounds (2001) 6 (4): 45. https://doi.org/10.1542/gr.6-4-45 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Idiopathic Intracranial Hypertension (Pseudotumor Cerebri). AAP Grand Rounds October 2001; 6 (4): 45. https://doi.org/10.1542/gr.6-4-45 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: pseudotumor cerebri Source: Salman MS, Kirkham FJ, MacGregor DL. Idiopathic “benign” intracranial hypertension: case series and review. J Child Neurol. 2001;16:465–470. Chronic, recurring headache is a common symptom in children, with an increasing prevalence in recent years variously estimated at 5 to 11%,1 which is most often due to migraine or tension. Idiopathic intracranial hypertension (IIH) is an uncommon cause which requires prompt diagnosis and appropriate management to prevent vision loss. The authors retrospectively reviewed the diagnosis and treatment of 32 patients with IIH from Toronto, Canada and London, UK aged 2 to 17.5 years. Twenty-three (72%) were female. The most common presenting symptoms were headache (91%), nausea and vomiting (56%), double vision (38%), and visual loss or blurring (25%). Signs at presentation included papilledema (97%), VIth cranial nerve palsy (31% unilateral, 9% bilateral), decreased visual acuity (29%), retinal hemorrhages (13%), and constricted visual fields (12%). Associated disorders in 19/32 included obesity in 48%, recent or recurrent otitis media (28%), upper respiratory tract infection (16%), sinusitis (13%), Addison’s disease and thyroiditis in 1 patient, and sudden withdrawal of cyproterone acetate for precocious puberty in 1. In all cases, CT or MRI excluded hydrocephalus, space-occupying lesion, and sinus venous thrombosis. All but one had an opening CSF pressure of >20 cm. None developed tonsillar herniation after lumbar puncture (LP). Treatments intended to alleviate symptoms and prevent visual loss included acetazolamide as first line treatment (44%), corticosteroids (short course) used for deteriorating visual loss or persistent headache (34%), lumboperitoneal shunt (25%), optic nerve fenestration (16%), and repeat LP (25%). Combination treatments were used in 40%. Four (13%) received no treatment. Four recovered after the first LP and never required further therapy. None of these therapies has been proven to be effective in randomized controlled trials. Idiopathic benign intracranial hypertension or pseudotumor cerebri is defined as an increase in intracranial pressure in the absence of a space-occupying lesion. In children, 90% of cases occur in the 5- to 15-year age range, and only 10% in infants and those under 5 years.2 In adults, the mean age at diagnosis is 28 years (range, 15–40).3 Neuroimaging to exclude a mass lesion, hydrocephalus, or venous thrombosis usually shows a normal or small ventricular system or, in young children, separated skull sutures. After excluding a surgical lesion, the diagnosis is confirmed by demonstrating elevated CSF pressure on LP. In some cases, CSF pressure may rise intermittently so a normal, single reading does not exclude the diagnosis. CSF analysis is normal or shows a mild pleocytosis. Because of the risk of tonsillar herniation during LP, patients with definite papilledema and/or retinal hemorrhages are probably best referred to a neurosurgeon or neurologist for LP. Known causes of IIH include recent or recurrent otitis media, venous sinus thrombosis, mastoiditis, hypervitaminosis A, recent administration of tetracycline or other antibiotic, and sudden withdrawal or prolonged use of steroids. To alleviate headache and prevent visual impairment, a normal CSF pressure must be maintained and confirmed by repeated... You do not currently have access to this content.

Postpartum Gigantomastia: A Case Report and Review of the Literature

Postpartum Gigantomastia: A Case Report and Review of the Literature

Enlargement of the third ventricle and hyponatraemia in aneurysmal subarachnoid haemorrhage.

Hyponatraemia following aneurysmal subarachnoid haemorrhage is associated with an increased risk of cerebral infarction. Whether the development of hyponatraemia was related to enlargement of the third ventricle on the admission CT scan was investigated in a consecutive series of 133 patients who were seen within 72 hours of aneurysmal haemorrhage. Hyponatraemia occurred significantly more often in patients with enlargement of the third ventricle (with or without dilatation of the lateral ventricles) than in patients with a normal ventricular system (20/41 versus 24/92, p = 0.016). After ventricular drainage, the sodium levels returned to normal in two patients in whom the size of the third ventricle decreased and not in four patients with persistent enlargement of the third ventricle. The significant relationship between enlargement of the third ventricle and hyponatraemia remained after adjustment for the amount of cisternal blood, but not after adjustment for the amount of intraventricular blood. These results suggest that the size of the third ventricle is an important but not the only factor in the relationship between acute hydrocephalus and hyponatraemia in patients with aneurysmal subarachnoid haemorrhage.

Experimental transcerebral fistula. Perineural olfactory CSF flow in the normal, hydrocephalic, and postoperative hydrocephalic dog shown by radionuclide ventriculography.

Cerebrospinal fluid dynamics were studied in eight dogs during normal, hydrocephalic, and postoperative phases. Radionuclide-labeled substances introduced into the normal ventricular system flow out of the exits from the fourth ventricle to the convexity subarachnoid spaces superiorly to be absorbed in the sagittal sinus, and basorostrally to the exits from the perineural olfactory sheath into the nose to produce physiological cerebrospinal fluid (CSF) rhinorrhea. Serial radionuclide ventriculography of the head following intraventricular isotope injection of labeled proteins and chelate into the kaolin-induced hydrocephalic system shows a high degree of ventricular stasis with no perineural olfactory nerve flow (rhinorrhea). An operative transcerebral fistula, fashioned from a dilated lateral ventricle to the convexity subarachnoid space, reestablishes perineural olfactory flow of CSF into the nose, as demonstrated by the radionuclide ventriculography studies. This suggests a potential method for treatment of hydrocephalus. Serial imaging studies in this surgically modified system clearly demonstrate radionuclide flow through the patent fistula to distal absorption sites, thereby bypassing the basal obstruction. Moreover, augmented CSF pressures associated with obstructive hydrocephalus can be controlled by such treatment. The application of this method in treating clinical hydrocephalus is discussed with emphasis on fistula arachnoid closure to assure fistula patency.

B-mode echoencephalography in the normal and high risk infant.

Commercially available high resolution, contact, gray scale imaging systems can now dependably visualize the normal and abnormal ventricular system as well as some other intracranial structures in all newborns. On 25 normal infants and 41 high risk infants, 135 B-mode echoencephalograms were performed. The technique for obtaining these scans is described. The normal lateral ventricle at the midbody in term infants is 0.9--1.3 cm wide (mean, 1.1 cm). Normal ratio of lateral ventricle to hemisphere is 28% (range, 24%--30%). High risk premature infants have a ratio of 31% (range, 24%--34%). The demonstration of hydrocephalus and cystic intracranial masses is reliable and the correlation with computed tomography is excellent. Postoperative or high risk infants can be repeatedly evaluated without radiation, at a lower cost, and more rapidly with ultrasound than with computed tomography. Ventricular size can be closely monitored and shunt failure detected at any early stage.

Measurement of the normal ventricular system and supratentorial subarachnoid space in children with computed tomography

The normal ventricular system and subarachnoid space were evaluated on the CT scans of 155 children chosen from 1,400 pediatric CT examinations, and linear measurements were made. The left septum-caudate distance was greater than the right, and the width of the left anterior horn and size of the skull were larger in boys. The interhemispheric and sylvian fissures, the third ventricle and Evans' ratio were larger in the younger group (less than 3 years) than in the older (greater than or equal to 3 years), while the opposite was found for the cella media index and size of the skull. The size of the lateral ventricles (expressed by anterior horn width, septum-caudate distance and width of cella media) was not different in the two age groups of children. Normal limits for the linear measurements and indices are given in Table 2.

Measurements of the normal ventricular system and hemispheric sulci of 100 adults with computed tomography

The brains of 100 normal adults were examined with 160 X 160 matrix computed tomography (CT). The left lateral ventricle was found to be larger than the right in both sexes, and both lateral ventricles were larger in the male. There was a statistically significant increase of all cerebral parameters with age, and the cella media index showed a correspondingly small decrease with age. The linear measurements of the lateral ventricles demonstrated positive correlation to cranial size, while the widths of the third ventricle and of the hemispheric sulci were independent of the size of the skull.

Measurements of the normal ventricular system with computer tomography of the brain. A preliminary study on 44 adults.

The brains of 44 normal adults were examined by computer tomography (CT) with the fine matrix EMI scanner. Measurements of various parts of the ventricular system showed a sexual difference and an increase with age. Absolute measurements are preferred to indices or ratios. Comparison with the same parameters in pneumoncephalography and ventricular casts showed good correlation. The need for larger investigations of the normal population is stressed.

Pseudotumor Cerebri Syndrome Without Papilledema

An obese, young woman exhibited the classical features of pseudotumor cerebri syndrome, including increased intracranial pressure, normal cerebrospinal fluid and ventricular system, and absence of focal neurologic signs. Despite elevated intracranial pressure of sufficient magnitude to produce bilateral sixth-nerve palsy, papilledema did not develop. The illness resolved spontaneously and on examination 1 1/2 years later, the patient was normal. There are several possible mechanisms that might prevent papilledema from developing under these circumstances.

Pseudotumor cerebri associated with idiopathic cryofibrinogenemia. Report of a case.

THE usual criteria for the diagnosis of pseudotumor cerebri are increased intracranial pressure, nonfocal neurologic signs, normal cerebrospinal fluid (CSF), and a normal ventricular system.1,2The syndrome has been seen in various metabolic disorders and following thrombosis of one or more dural sinuses. We are reporting what we believe to be the first case of idiopathic cryofibrinogenemia associated with multiple dural sinus thromboses that led to the development of pseudotumor cerebri. Report of a Case Clinical Course.— A 23-year-old man was well until December 1967, when he developed pyelonephritis and was treated with oxytetracycline. That same month, he developed a deep phlebitis in the left leg after shoveling snow. He was admitted to another hospital and was treated with anticoagulants. The phlebitis improved, and he was discharged in January 1968. Shortly after discharge, he complained of throbbing frontal headaches. Later he developed photophobia and blurred vision. After being