Normal Pressure Hydrocephalus in a Girl Child with Blake's Pouch Cyst

A 4 yrs old baby girl presented with history of gait instability with recurrent fall without loss of consciousness since last 1 yr. with recently having urinary and fecal incontinence off and on after being continent earlier. She did not have any febrile illness or convulsion or vomiting. There was no history of consanguinity or birth injury. Examination revealed no facial dysmorphism; her speech and language were delayed with borderline delayed developmental milestones. Her gait was ataxic with hesitant steps, magnetic in nature characteristic of frontal gait disorder. She was provisionally diagnosed as normal pressure hydrocephalus. MRI brain images revealed infracerebellar Blake's pouch cyst with dilatation of lateral, 3rd and 4th ventricles with normal subarachnoid bathing. She was referred to pediatric neurosurgeon for assessment and intervention for possible 3rd ventriculostomy.