Hydrocephalus, gross anatomy

Hydrocephalus usually causes symptoms of increased intracranial pressure.  If it occurs before the closure of the cranial sutures, the patient may develop megacephaly.  In this patient, the obstruction of the cerebral aqueduct must have occurred after closure of the sutures, and over time, so that the pressure building up in his ventricles slowly produced cerebral atrophy.

“Patient was 60 years old. At one point possessed considerable intellect as well as musical ability and ability to work. Later in life became blind, partially deaf, with some spasticity of lower limbs. Never had convulsive attacks, fair health aside form brain disease.

Brain 1,240 g when emptied, contained 2,400 cubic centimeters of fluid.”


image from Illustrations of the Gross Morbid Anatomy of the Brain in the Insane. I.W. Blackburn, 1908. via biomedicalephemera tumblr (link)

You can see here the extreme results of the blockage of the cerebral aqueduct connected to the fourth ventricle.

On outward appearance, the patient appeared normal (aside from a slight bulging of the eyes).  Interestingly, though this man lost many of his basic functions due to the increasing severity of his hydrocephalus over the last part of his life (as the pressure in his ventricles led to cerebral atrophy), he actually retained a fair amount of intelligence and ability to reason and speak.  This is because his frontal and prefrontal cortex (his frontal lobe) were less affected than the remaining lobes of the brain.

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