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In 10% of adult patients with hydrocephalus, the cause is because of aqueductal stenosis (AS), causing enlargement of the lateral and third ventricles. (1) 40 year gentleman presented with progressively increasing headache of three weeks duration with off and vomiting and mild relief in headache after vomiting. He had 3-4 episodes of loss of consciousness and it was associated with decerebrate posturing. There were no tonic clonic movements. At the time of presentation to emergency his general and systemic examination was normal. On examination, he was conscious and oriented. His higher mental functions were normal. Fundus examination revealed bilateral papilloedema. There were no motor, sensory, or cerebellar signs, and no signs of meningitis. His plain CT scan showed dilated third and lateral ventricles and a hypodense lesion in the posterior third ventricular region (Figure 1). A diagnosis of third ventricular tumor with obstructive hydrocephalus was suspected. In view of multiple hydrocephalic episodes he underwent right ventriculo-peritoneal shunt in emergency. He improved in his headache and doing well. He was planned for MRI and it showed reduction in the size of the ventricles (Figure 2 A-D). Mass in the posterior third was disappeared and aqueductal stenosis was apparent. The fourth ventricle was disproportionately small. All these features were suggestive of adult onset aqueductal stenosis.

Letter to the editor: Extensive dilatation of third ventricle masking the diagnosis of aqueductal stenosis