When Stroke Leads to Hydrocephalus: A Case of Unilateral Ventricular Enlargement

Unilateral hydrocephalus is a rare form of ventricular enlargement, typically resulting from obstruction of the cerebrospinal fluid (CSF) flow at the foramen of Monro. Unilateral hydrocephalus is rarely reported as a complication of recurrent ischemic stroke. While tumours, cysts, and infections are common etiologies, vascular causes are rarely reported. We present a 58-year-old female patient who presented to the emergency room in an irritable state. She also had acute right-sided weakness of upper and lower limbs along with aphasia. Neuroimaging revealed Gliosis with encephalomalacic changes in the left fronto-temporal lobes and left capsuloganglionic region, causing ipsilateral dilatation of the left lateral ventricle. The likely mechanism involved post-stroke gliosis and obstruction of CSF pathways. This case highlights the importance of recognising atypical causes of hydrocephalus in stroke patients, especially when clinical deterioration is disproportionate to infarct size. Need to prevent irreversible neurological damage in this condition, so diagnosis and prompt treatment are required.