A 67-year-old-man with learning difficulties presented with worsening confusion, urinary incontinence and impaired mobility. A computed tomography (CT) scan, followed by an magnetic resonance imaging (MRI) scan of the brain demonstrated dramatic appearances, including massive lateral and third ventriculomegaly with gross displacement of the surrounding supra-tentorial brain substance. The point of obstruction appears to be the central aqueduct and this is clearly chronic in nature and was thought to account in part for his previous diagnosis of ‘learning difficulties’.
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