Decreased Craniocervical CSF Flow in Patients with Normal Pressure Hydrocephalus: A Pilot Study

✓ Eight patients with “normal pressure hydrocephalus” are presented who demonstrated radiographic and occasional clinical evidence of progressive dilatation of the ventricles following pneumoencephalography. The characteristic pneumographic signs of tentorial obstruction to the flow of cerebrospinal fluid (CSF) had been documented in the original air contrast study. The authors postulate that pneumoencephalography in patients with normal pressure hydrocephalus may result in a sudden displacement of CSF from the ventricles into the already compromised basal cisterns, leading to further obstruction of CSF outflow and progressive ventricular dilatation. Other mechanisms such as reduction in the potential resorptive capacity of the ventricular ependyma by air replacing ventricular fluid may play a part. The value of repeat radiological studies 24 and 48 hours after the original pneumogram is emphasized both as an aid in the radiological diagnosis of normal pressure hydrocephalus and as an additional parameter for studying problems in CSF flow and absorption.

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Cine-MR Imaging of Aqueductal CSF Flow in Normal Pressure Hydrocephalus Syndrome before and after CSF Shunt

Acta Radiologica ◽

10.1177/028418519303400612 ◽

1993 ◽

Vol 34 (6) ◽

pp. 586-592 ◽

Cited By ~ 18

Author(s):

M. Mascalchi ◽

G. Arnetoli ◽

D. Inzitari ◽

G. Dal Pozzo ◽

F. Lolli ◽

...

Keyword(s):

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

Csf Shunt ◽

Communicating Hydrocephalus ◽

Csf Flow ◽

Cine Mr ◽

Csf Shunting ◽

Before And After ◽

Flow Void ◽

Central Flow

Reproducibility of the aqueductal CSF signal intensity on a gradient echo cine-MR sequence exploiting through plane inflow enhancement was tested in 11 patients with normal or dilated ventricles. Seven patients with normal pressure hydrocephalus (NPH) syndrome were investigated with the sequence before and after CSF shunting. Two patients exhibiting central flow void within a hyperintense aqueductal CSF improved after surgery and the flow void disappeared after shunting. One patient with increased maximum and minimum aqueductal CSF signal as compared to 18 healthy controls also improved and the aqueductal CSF signal was considerably decreased after shunting. Three patients with aqueductal CSF values similar to those in the controls did not improve, notwithstanding their maximum aqueductal CSF signals decreasing slightly after shunting. No appreciable aqueductal CSF flow related enhancement consistent with non-communicating hydrocephalus was found in the last NPH patient who improved after surgery. Cine-MR with inflow technique yields a reproducible evaluation of flow-related aqueductal CSF signal changes which might help in identifying shunt responsive NPH patients. These are likely to be those with hyperdynamic aqueductal CSF or aqueductal obstruction.

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MRI of CSF Flow in Normal Pressure Hydrocephalus

Annual Review of Hydrocephalus ◽

10.1007/978-3-662-11158-1_13 ◽

1991 ◽

pp. 22-24

Author(s):

Gerhard Schroth ◽

Uwe Klose

Keyword(s):

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

Csf Flow

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Measurement of Cerebrospinal Fluid Flow: Technique Validation in a Patient with Idiopathic Normal Pressure Hydrocephalus

Rivista di Neuroradiologia ◽

10.1177/197140090501800104 ◽

2005 ◽

Vol 18 (1) ◽

pp. 34-36

Author(s):

A. Romano ◽

A. Bozzao ◽

G. Trillò ◽

M. Bonamini ◽

F. Fasoli ◽

...

Keyword(s):

Normal Pressure Hydrocephalus ◽

Phase Contrast ◽

Normal Pressure ◽

Third Ventriculostomy ◽

Csf Flow ◽

Flow Measurements ◽

Cerebrospinal Fluid Flow ◽

Functional Changes ◽

Before And After ◽

Long Term Follow Up

This study aimed to assess anatomical and functional changes disclosed by magnetic resonance imaging in a patient with suspect normal pressure hydrocephalus following surgical third ventriculostomy with placement of a ventriculoperitoneal shunt. The patient was investigated by phase contrast sequences to calculate CSF flow in the Sylvian aqueduct before and after the two surgical procedures. In addition, T1-weighted volumetric MPRAGE images were acquired using voxel-based morphometry to study any changes in size of the ventricular system and CSF in the subarachnoid spaces before and after surgery. CSF flow measurements were closely correlated with the patient's clinical course, increased CSF flow coinciding with worsening symptoms, and a decrease in flow noted after surgery. There were no significant changes in the CSF volumes analyzed. Phase contrast technique proved reliable and effective for the purposes of diagnosis and long-term follow-up in patients with suspect normal pressure hydrocephalus eligible for surgery

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Correlation Between Lumbo-Ventricular Perfusion and MRI-CSF Flow Studies in Idiopathic Normal Pressure Hydrocephalus

Surgical Neurology ◽

10.1016/s0090-3019(97)00032-3 ◽

1998 ◽

Vol 49 (1) ◽

pp. 14-20 ◽

Cited By ~ 20

Author(s):

Rodolfo Hakim M.D. ◽

Peter McL Black M.D., Ph.D.

Keyword(s):

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Csf Flow

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Normal Pressure Hydrocephalus Associated with COVID-19 Infection: A Case Report

10.21203/rs.3.rs-654791/v1 ◽

2021 ◽

Author(s):

Thaís de Maria Frota Vasconcelos ◽

Paulo Ribeiro Nóbrega ◽

Glauber de Menezes Ferreira ◽

Moysés Loiola Ponte de Souza ◽

Alander Sobreira Vanderlei ◽

...

Keyword(s):

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

Gait Disorder ◽

Causal Association ◽

Cytokine Release ◽

Resonance Imaging ◽

Csf Flow ◽

Tap Test ◽

History Of ◽

Magnetic Resonance Imaging Mri

Abstract COVID-19 is a pandemic disease responsible for a large number of deaths worldwide. Many neurological manifestations have been described. We report a case of normal pressure hydrocephalus (NPH) two months after acute COVID19 infection, in a patient without other risk factors. A 45-year-old male patient presented an 8-month history of progressive gait disorder and cognitive impairment after being hospitalized for SARS-CoV-2 infection. Magnetic resonance imaging (MRI) was compatible with NPH. A spinal tap test was positive and there was progressive improvement after shunting, with complete resolution of symptoms. Other infections such Syphilis, cryptococcosis and Lyme disease have been associated with NPH. Possible mechanisms for NPH after COVID include disruption of choroid plexus cells by direct viral invasion or as a result of neuroinflammation and cytokine release and hypercoagulability leading to venous congestion and abnormalities of CSF flow. Given the significance of NPH as a cause of reversible dementia, it is important to consider the possibility of a causal association with COVID19 and understand the mechanisms behind this association.

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