What causes boxcar ventricles in the brain on MRI or CT imaging?
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Answer:
Boxcar ventricles result from marked bilateral atrophy of the caudate nuclei leading to compensatory dilatation of the lateral ventricles. This sign is commonly seen in neurodegenerative conditions such as Huntington’s disease. The atrophy of the caudate causes the lateral ventricles to enlarge in a box-like shape rather than the typical rounded or irregular morphology.
Why is it called so?
The term “boxcar ventricles” is derived from the resemblance of the dilated lateral ventricles’ shape to boxcars of a train — rectangular and segmented, reflecting the geometric outline formed by the atrophic caudate nuclei margins.
Pathophysiology
Neuronal loss and gliosis in the caudate nucleus cause volume loss and loss of the normal curved contour around the lateral ventricles. This leads to focal dilatation and straightening of the ventricular walls adjacent to the caudate, producing the characteristic box-like ventricular shape on axial imaging.
Alternative names: None
Other associated named signs: None
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