From the Guidelines
The boxcar ventricle sign is not mentioned in the provided evidence, however, based on general medical knowledge, it is seen in conditions affecting the brain, particularly those involving severe dehydration or cerebral atrophy. The provided evidence discusses arrhythmogenic right ventricular cardiomyopathy (ARVC) and its diagnosis, but does not mention the boxcar ventricle sign.
- Key features of ARVC include ventricular arrhythmias with LBBB morphology, precordial T-wave inversion, and QRS duration greater than 110 ms 1.
- The evidence highlights the importance of considering ARVC in patients with ventricular arrhythmias, particularly those with a family history of the condition or symptoms such as syncope and presyncope.
- However, the boxcar ventricle sign is not a feature of ARVC, and its presence would suggest a different underlying condition, potentially requiring distinct management and treatment.
- In clinical practice, recognizing the boxcar ventricle sign would prompt further investigation into the underlying cause, which could include severe dehydration, cerebral atrophy, or other conditions affecting the brain.
From the Research
Boxcar Ventricle Sign
- The boxcar ventricle sign is typically seen in patients with hydrocephalus, particularly those with normal pressure hydrocephalus (NPH) 2.
- This sign is characterized by the enlargement of the ventricles, which can be caused by the accumulation of cerebrospinal fluid (CSF) in the ventricles 3.
- The boxcar ventricle sign can be observed on imaging studies, such as MRI or CT scans, and is often associated with other symptoms of hydrocephalus, including gait disturbance, urinary incontinence, and dementia 4.
- The treatment of hydrocephalus, including the boxcar ventricle sign, often involves the placement of a ventriculoperitoneal (VP) shunt to divert excess CSF from the ventricles into the peritoneal cavity 5, 6.
- However, shunt failure and complications are common, and may require multiple surgical procedures during a patient's lifetime 6.
Causes and Associations
- The boxcar ventricle sign is often associated with NPH, but can also be seen in other types of hydrocephalus, including congenital hydrocephalus, posthemorrhagic hydrocephalus, and tumor-related hydrocephalus 4.
- The sign can be caused by a variety of factors, including the accumulation of CSF, ventricular enlargement, and CSF backflow into the brain through the ventricles 2.
- The boxcar ventricle sign can also be associated with other neurological conditions, including cerebral palsy, visual and hearing impairment, epilepsy, and seizures 4.