The histopathological changes in shunted hydrocephalic children with slit ventricle syndrome have never been described. Periventricular gliosis is presumed to be an important feature. A girl who was shunted in infancy following meningitis developed headaches at 10 years of age and suffered a respiratory arrest, from which she was resuscitated. CT scan of the head showed very small ventricles. A diagnosis of slit ventricle syndrome was made. She died 33 h later. Autopsy revealed a large head and brain, small ventricles with glial adhesions, obstruction of the cerebral aqueduct, complete obstruction of the shunt catheter and reactive astroglia in the periventricular white matter. The latter change was no more severe than in hydrocephalic children with enlarged ventricles who have died following shunt failure. Periventricular astrogliosis may not necessarily be the major determinant of the slit ventricle syndrome.

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