Biventricular hydrocephalus due to idiopatic occlussion of foramina of Monro.

Total congenital occlusion of the foramina of Monro in adults is extremely rare. Only 9 cases have been reported. Clinically, this manifest as a biventricular hydrocephalus and the most frequent presenting symptom is headache. The diagnosis can be confirmed by computed tomographic scan or magnetic resonance imaging. Regarding treatment, neuroendoscopy constitutes the procedure of choice. The prognosis is usually good. We describe a 35-year-old woman with a 2-month headache and sudden nausea, vomiting, and syncope. The patient was studied with computed tomograph, magnetic resonance imaging, and a ventricular infusion test, and subsequently treated with endoscopic foraminoplasty and a ventriculoperitoneal shunt. The protacted normal neurological history with late and rapid onset of symptoms speaks for a progressive restriction of the size of the foramina of Monro, which allows adaptation to the changes in cerebrospinal fluid dynamics. Regarding treatment, in almost every cases of bilateral occlusion of foramina of Monro reported to date, but in 1 case both: neuroendoscopy fenestration and the ventriculoperitoneal shunt were needed. Time is needed to allow cerebrospinal fluid dynamics and the ventricular system to normalize.