Subjects and methods Twenty patients with neurological symptoms who were admitted for elective investigation, including lumbar puncture, were studied. There were eight males aged from 25-71 years (mean 41-5 years) and 12 females aged from 14-64 years (mean 38-5 years). Each patient underwent measurements of their intracranial CSF volume, before LP and 24 hours afterwards. Each patient gave written informed consent for MRI. Patients were excluded if they were being investigated for headaches, if they complained of headache at the time of admission or if they were taking analgesics. Patients were excluded if they were having contrast mylography. At the time of the second MRI scan, the patient was questioned about headache. Patients were contacted also three to four weeks later to determine whether they had experienced headache and, if so, its severity and duration.Spinal puncture was performed with the patient in the curled lateral recumbent position. All punctures were performed in the lumbar region with an 18 gauge needle. The CSF "opening" pressure was measured using a clinical manometer, 10 mls of CSF were collected for analysis and CSF "closing" pressure was then measured. The CSF was sent for biochemical, neuroimmunological and bacteriological analysis. The patient was advised to remain in bed for at least 14 hours.
Brain volume is altered by pathological processes such as swelling or atrophy yet until now this is a parameter which could only be determined at post mortem. This paper describes a non-invasive technique using MRI which permits the in vivo determination of brain volume (BV), intracranial cavity volume (ICV), ventricular, cortical sulcal and total intracranial CSF volumes. The technique was applied to 40 normal volunteers (20 males, 20 females) to investigate the variation of these parameters with age and sex after normalisation with respect to ICV. There was found to be a significant decrease in normalised brain volume between the ages of 20 and 60 years in males by 1.6% per decade. In females the decrease was less (0.5%) but was not statistically significant. This technique will make it possible, for the first time, to investigate prospectively the correlation between mental function and brain volume in illness and ageing.
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