The proposed distinction between familial and sporadic schizophrenia has proved a useful tool for research into the aetiology of the disorder although evidence for the proposed association between large cerebral ventricles and the sporadic form has been contradictory. We have reviewed the literature and found evidence that in the context of brain structure, the familial — sporadic distinction may apply to men but not women with schizophrenia. This may explain some of the observed sex differences in schizophrenia and some of the confusion in the literature. Based upon this review, we examined our own data on 138 schizophrenic subjects with no family history (sporadic) and 24 with such a history (familial). As predicted, cerebral ventricle size was largest in men with sporadic schizophrenia, there being no effect in women. We propose a meta-analysis of existing data in order to pursue this phenomenon further.