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Case of the Month: December 2013, Page 3
E. Benign external hydrocephalus. CT images reveal and enlarged extra axial space with fluid density that of CSF and a bulging anterior fontanelle.
- Benign external hydrocephalus or Benign enlargement of the subarachnoid spaces (BESS) is typically characterized clinically by macrocrania and frontal bossing.
- BESS is more common in males and there is often a family history of macrocrania.
- It is theorized to be due to a delay in development of arachnoid villi in the saggital sinus leading to faulty CSF resorption.
- Imaging features include:
- Widening of bifrontal CSF spaces > 5mm
- No flattening of adjacent gyri
- Enlarged anterior fontanelle
- Normal ventricle size and no atrophy
- No blood products
- No cortical vein displacement
- The enlarged subarachnoid fluid collection usually resolves by age 2, however, the macrocrania may persist.
- While BESS is typically benign, there have been reported associations with increased risk of subdural hemorrhage, communicating hydrocephalus, and psychomotor delay.
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