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The CSF can flow down its usual pathway, but it is beginning to become obstructed by the enlarged III ventricle. Unless treated, obstructive hydrocephalus will develop.
When a cyst communicates (is continuous with) one of the ventricles, it is usually congenital (formed during pregnancy). Here we see a large cerebellar cyst communicating with an enlarged IV ventricle. The III ventricle is mildly enlarged as well. Is this early hydrocephalus?
This patient was in her 60's and did not even know she had a porencephalic cyst. It was found when she had an MRI of the brain after she had some symptoms referable to a possible minor stroke. She always had some mild coordination problems, but never thought much of it.

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