# Long-Standing Overt Ventriculomegaly in Adults (LOVA) With Absent Septum Pellucidum and Spontaneous Ventriculostomy: Report of a Rare Case

## TL;DR

A 20-year-old man with rare brain ventricle enlargement and structural abnormalities showed mild symptoms despite severe MRI findings.

## Contribution

This report presents a rare case of LOVA with absent septum pellucidum and spontaneous ventriculostomy.

## Key findings

- MRI showed massive ventriculomegaly with an Evan's index of 0.44.
- The patient had coexisting aqueductal stenosis, absent septum pellucidum, and spontaneous ventriculostomy.
- Clinical symptoms were mild despite severe imaging findings.

## Abstract

Long-standing overt ventriculomegaly in adults (LOVA) is a type of chronic hydrocephalus with presumable infant onset characterized by macrocephaly and massive ventriculomegaly that causes clinical presentations in later adult life. We report a case of a 20-year-old man who was referred from the ophthalmology department for further investigation of his visual disturbances. MRI of the head revealed massive ventriculomegaly with an Evan's index of 0.44. A careful investigation revealed coexisting aqueductal stenosis, absent septum pellucidum, ventricular rupture, and spontaneous ventriculostomy. The clinical presentations were relatively mild compared to his MRI findings. He was referred to a neurosurgeon for potential surgical interventions after the administration of conservative hyperosmolar drugs and neuroprotective agents.