Focal dilation and paradoxical collapse of cortical fissures and sulci in patients with normal-pressure hydrocephalus.

Publication Type	Case Report
Authors	Holodny A, George A, de Leon M, Golomb J, Kalnin A, Cooper P
Journal	J Neurosurg
Volume	89
Issue	5
Pagination	742-7
Date Published	11/01/1998
ISSN	0022-3085
Keywords	Hydrocephalus, Normal Pressure
Abstract	OBJECT: The authors describe a subgroup of patients with shunt-proven normal-pressure hydrocephalus (NPH) who presented with focal fissural and sulcal dilation on imaging studies. The specific radiological features and methods of differentiating this condition from cortical atrophy are delineated. METHODS: Normal-pressure hydrocephalus has been described as dilation of the ventricles that is out of proportion to the sulci. Sulcal dilation has been taken as evidence of cortical atrophy and has even been used as a criterion to exclude patients from undergoing a shunting procedure. The authors describe five cases of patients with shunt-proven NPH who presented with focal dilation of cortical fissures and sulci. In three of the cases, there was a paradoxical decrease in the size of the dilated fissures and sulci that paralleled the decrease in the size of the lateral ventricles following successful shunting. CONCLUSIONS: This study demonstrates that focal fissural and sulcal dilation may represent reservoirs of cerebrospinal fluid analogous to the ventricular system. Patients should not be denied a shunting procedure solely on the basis of focally dilated fissures of sulci.
DOI	10.3171/jns.1998.89.5.0742
PubMed ID	9817411