Friday, 18 November 2011

Mild lateral ventricle Asymmetry

First of all rule out obliquity and improper alignment of pt's head during scanning, the major source of error during assessment of asymmetry of lateral ventricle and cerebral hemispheres.
Next is grading of asymmetry, as mild moderate and severe.

Mild asymmetry is usually seen secondary to off midline septum pellucidum, where rest of the lateral ventricle  and its horns are symmetrical, normal and non dilated. Adjacent basal ganglia show normal volume and density.

Prevalence of mild asymmetry of lateral ventricle in our routine opd work load is approximately 5 percent. Headache was the most common symptom in pt with asymmetry of lateral ventricle and were treated conservatively. Seizures was the second common complaint in this group. Giddiness and neuropsychiatric problems like schizophrenia in few. Widening of left lateral ventricle is more common that right. No obvious association found between asymmetry of lateral ventricle with right or left handedness.

To pass if off as normal finding or variant, it should be an isolated finding, without any obvious cause like volume loss due to an adjacent basal ganglionic gliosis or atrophy, without any intra ventricular or para ventricular space occupying lesion,  without any trapping lateral ventricular secondary ependymal adhesions.
It is important to differentiate between moderate and severe asymmetry of lateral ventricle from unilateral hydrocephalus which is done by using three different ventricle to brain ratios (V/B ratios).

Mild asymmetry in lateral ventricle can be passed off as a normal anatomical variation if not associated with any intra ventricular or adjacent parenchymal abnormality; at the most make a note of finding in the report. Moderate and severe degree of asymmetry of lateral ventricle should not be overlooked, search for possible accompanying pathology or association with cognitive disorders. 

Related Posts:
Unilateral hydrocephalus
Post shunt lateral ventricle asymmetry


Vinodh said...

Sir i took my ct scan and i have mild asymmetry of lateral ventricles seen R>L. before i took ct scan. i experienced a small problem. i tried to write some numbers i found i could not write it properly or clearly my hand did not cooperate. Rest i was fine and everything was normal. Also i keep getting pains in my thighs at different times but only for one minute or so. What can be my real problem. Please help me.

Dr Dhanesh Vijayan said...

In this case the left lateral ventricle appears larger than the right, in the posterior body region also, not only at the frontal horn level. So is it OK to suggest this as essentially a normal variant?

Jenny Blanco said...

I had an MRI of my brain done and I have mild congenital lateral ventricular asymmetry. Accompanied with bilateral dilated perivascular spaces. A cyst on my pineal gland. Partially empty sella and left concha bullosa. Should I be concerned?