Measurement of Blood Flow in the Superior Sagittal Sinus in Healthy Volunteers, and in Patients with Normal Pressure Hydrocephalus and Idiopathic Intracranial Hypertension with Phase-Contrast Cine MR Imaging

1996 ◽  
Vol 37 (2) ◽  
pp. 171-176 ◽  
Author(s):  
P. Gideon ◽  
C. Thomsen ◽  
F. Gjerris ◽  
P. S. Sørensen ◽  
F. Ståhlberg ◽  
...  
1996 ◽  
Vol 37 (1P1) ◽  
pp. 171-176 ◽  
Author(s):  
P. Gideon ◽  
C. Thomsen ◽  
F. Gjerris ◽  
P. S. Sørensen ◽  
F. Ståhlberg ◽  
...  

Purpose: To measure blood flow and velocity in the superior sagittal sinus. Material and Methods: MR velocity mapping was used to examine 14 healthy volunteers, 15 patients with normal pressure hydrocephalus (NPH), 3 patients with high pressure hydrocephalus (HPH), and 11 patients with idiopathic intracranial hypertension (IIH). Results: Mean blood flow was 443 ml/min in healthy volunteers with a tendency towards reduced blood flow with increasing age. In NPH patients significantly lower superior sagittal sinus blood flow values were found, but this difference was no longer significant when patients and controls were matched for age. In HPH and IIH patients blood flow and velocity were within the normal range. In one patient with thrombosis of the superior sagittal sinus the blood flow was reduced to 40 ml/min. Conclusion: MR velocity mapping methods may be of value in the assessment of blood flow in the dural sinuses in various pathologies resulting in dural sinus occlusion, such as dural sinus thrombosis, and for following the progress of these patients while undergoing treatment.


Neurosurgery ◽  
2008 ◽  
Vol 62 (2) ◽  
pp. 431-436 ◽  
Author(s):  
Benjamin M. Greenberg ◽  
Michael A. Williams

Abstract OBJECTIVE Spinal catheters are often inserted for treatment of cerebrospinal fluid leaks; however, they have recently been recommended for elective cerebrospinal fluid drainage to identify patients with possible normal pressure hydrocephalus who are most likely to respond to shunt surgery. The rate of spinal catheter-associated meningitis with elective spinal catheter insertion is unknown. The objective was to determine the rate of infection and risk factors associated with elective spinal catheter insertion for evaluation of hydrocephalus and idiopathic intracranial hypertension (IIH). METHODS We retrospectively analyzed clinical and microbiological data and cerebrospinal fluid results of patients admitted during 60 consecutive months who had elective spinal catheter insertion for evaluation of normal pressure hydrocephalus or IIH. RESULTS A total of 461 spinal catheters were inserted in 454 patients, including 419 (90.9%) for treatment of hydrocephalus and 42 (9.1%) for IIH. The infection rate was 3.3% (15 out of 461 patients) for the entire cohort, 3.6% (15 out of 419 patients) for the hydrocephalus cohort, and 0% for the IIH cohort. There was one death (0.2%) in the hydrocephalus cohort. The infection rate was reduced and sustained at 1.8% for 225 catheters after the topical antiseptic was changed to chlorhexidine (two-sided Fisher's exact test; P = 0.114). CONCLUSION Although infection is the most serious complication of spinal catheter insertion for evaluation of hydrocephalus or IIH, the infection rate can be maintained below 2% with use of chlorhexidine topical antiseptic application, single-dose preprocedural antibiotic administration, and clinical surveillance of the patient. The benefit of cerebrospinal fluid drainage via spinal catheter for normal pressure hydrocephalus outweighs the risks associated with the procedure.


2011 ◽  
Vol 21 (4) ◽  
pp. 365-369 ◽  
Author(s):  
Nagato Kuriyama ◽  
Takahiko Tokuda ◽  
Kei Yamada ◽  
Kentaro Akazawa ◽  
Makoto Hosoda ◽  
...  

2015 ◽  
Vol 29 (4) ◽  
pp. 385-396 ◽  
Author(s):  
G. Iacob ◽  
Andreea Marinescu

Abstract Idiopathic intracranial hypertension - IIH (synonymous old terms: benign intracranial hypertension - BIH, pseudotumor-cerebri - PTC) it’s a syndrome, related to elevated intracranial pressure, of unknown cause, sometimes cerebral emergency, occuring in all age groups, especially in children and young obese womans, in the absence of an underlying expansive intracranial lesion, despite extensive investigations. Although initial symptoms can resolve, IIH displays a high risk of recurrence several months or years later, even if initial symptoms resolved. Results: A 20-year-old male, obese since two years (body mass index 30, 9), was admitted for three months intense headache, vomiting, diplopia, progressive visual acuity loss. Neurologic examination confirmed diplopia by left abducens nerve palsy, papilledema right > left. At admission, cerebral CT scan and cerebral MRI with angio MRI 3DTOF and 2D venous TOF was normal. Despite treatment with acetazolamide (Diamox), corticosteroid, antidepressants (Amitriptyline), anticonvulsivants (Topiramate) three weeks later headache, diplopia persist and vision become worse, confirmed by visual field assessment, visual evoked potential (VEP). A cerebral arteriography demonstrate filling defect of the superior sagittal sinus in the 1/3 proximal part and very week filling of the transverse right sinus on venous time. Trombophylic profile has revealed a heterozygote V factor Leyden mutation, a homozygote MTHFR and PAI mutation justifying an anticoagulant treatment initiated to the patient. The MRI showed a superior sagittal sinus, right transverse and sigmoid sinus thrombosis, dilatation and buckling of the optic nerve sheaths with increased perineural fluid especially retrobulbar, discrete flattening of the posterior segment of the eyeballs, spinal MRI showed posterior epidural space with dilated venous branches, with mass effect on the spinal cord, that occurs pushed anterior on sagittal T1/T2 sequences cervical and thoracic. The opening pression of lumbar puncture, done with the patient in the lateral decubitus position, was 60 cm H2O, the cytochemical CSF study were normal. The patient was operated: a lombo-peritoneal with a variable pressure valve was inserted. Two months after the patient general condition improved: he was without headache, abducens palsy and the visual field assessment, ocular motility examination, ophthalmoscopy were normal. Conclusion: IHH is rare, variable in evolution, and in many cases it disappears on its own within 6 months without affecting life expectancy. Weight loss, fluid or salt restriction, in conjunction with medical treatment, angioplasty and venous stenting across the sinus stenosis under general anesthesia and surgical treatment (shunting, optic nerve sheath decompression and fenestration, gastric by-pass surgery) are treatment alternatives. Such disorder should be closed monitored because 10 to 25% of cases could be affected by recurrencies or by permanent vision loss to those patients with resistant papilledema despite treatment.


1993 ◽  
Vol 34 (6) ◽  
pp. 586-592 ◽  
Author(s):  
Mario Mascalchi ◽  
G. Arnetoli ◽  
D. Inzitari ◽  
G. Dal Pozzo ◽  
F. Lolli ◽  
...  

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