The reversibility of reduced cortical vein compliance in normal-pressure hydrocephalus following shunt insertion

被引:57
作者
Bateman, GA [1 ]
机构
[1] John Hunter Hosp, Dept Med Imaging, Newcastle, NSW 2310, Australia
关键词
normal pressure hydrocephalus; cortical veins; pulsatility; compliance; ventricular shunting;
D O I
10.1007/s00234-002-0901-0
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Superficial cortical venous compression secondary to alterations in craniospinal compliance is implicated in the pathogenesis of normal pressure hydrocephalus (NPH). A reduction in the pulsation in the outflow of the cortical veins would be expected to occur following compression of these veins and this has been shown in NPH. If cortical vein compression is a causative factor in NPH, it would be expected that cortical vein compliance as measured by pulsatility would be significantly altered by a curative procedure i.e. shunt tube insertion. My purpose is to compare the blood flow pulsatility characteristics in a group of patients with NPH before and after shunt tube insertion. I initially studied 18 subjects without pathology with MRI flow quantification studies of the cerebral arteries and veins to define the range of normality. The main study involved 18 patients with idiopathic dementia and mild leukoaraiosis who served as controls and seven patients with NPH studied before and after shunt insertion. Arterial, superior sagittal and straight sinus pulsatility was not significantly different between the patients with idiopathic dementia and those NPH patients before or after shunting. Cortical vein pulsatility before shunting in the patients with NPH was 43% lower than in those with idiopathic dementia (P =0.006). Following shunting, cortical vein pulsatility increased by 186% (P = 0.007). There is thus reduced compliance in cortical veins in NPH which is significantly increased in patients who respond to insertion of a shunt tube. These findings suggest that reversible elevation in cortical vein pressure and reversal of the normal absorption pathway for cerebrospinal fluid may be behind the pathophysiology of NPH.
引用
收藏
页码:65 / 70
页数:6
相关论文
共 19 条
[1]  
Bateman GA, 2002, AM J NEURORADIOL, V23, P1180
[2]  
Bateman GA, 2000, AM J NEURORADIOL, V21, P1574
[3]   Renal vein Doppler Sonography of obstructive uropathy [J].
Bateman, GA ;
Cuganesan, R .
AMERICAN JOURNAL OF ROENTGENOLOGY, 2002, 178 (04) :921-925
[4]   Pulse-wave encephalopathy: a comparative study of the hydrodynamics of leukoaraiosis and normal-pressure hydrocephalus [J].
Bateman, GA .
NEURORADIOLOGY, 2002, 44 (09) :740-748
[5]   LIVER-CIRRHOSIS - CHANGES OF DOPPLER WAVE-FORM OF HEPATIC VEINS [J].
BOLONDI, L ;
LIBASSI, S ;
GAIANI, S ;
ZIRONI, G ;
BENZI, G ;
SANTI, V ;
BARBARA, L .
RADIOLOGY, 1991, 178 (02) :513-516
[6]  
CORDELL E, 1990, NEUROL RES, V12, P226
[7]   BRAIN EDEMA [J].
FISHMAN, RA .
NEW ENGLAND JOURNAL OF MEDICINE, 1975, 293 (14) :706-711
[8]  
GREITZ D, 1993, ACTA RADIOL, V34, P1
[9]  
Guyton A.C., 2000, TXB MED PHYSL, P152
[10]  
Hara M, 1985, No To Shinkei, V37, P365