Normal pressure hydrocephalus versus atrophic dilatation to distinguish and predict the benefits of surgical intervention with a phase-contrast MRI technique

Aslan, Kerim; Tokatlioğlu, Onur; Aydin, Recep; Polat, Ahmet Veysel; İncesu, Lütfi

doi:10.5137/1019-5149.jtn.9101-13.1

Cited by 5 publications

(5 citation statements)

References 19 publications

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“…Although no macroscopic obstruction is discernible on diagnostic imaging [ 4 , 17 ] some iNPH patients display elevated CSF outflow resistance [ 12 , 18 , 19 ] suggesting impaired CSF clearance and absorption. On the other hand, the CSF flow in iNPH patients appears hyperdynamic as demonstrated by an increased aqueductal CSF flow [ 20 – 24 ]. This hyperdynamic CSF flow may originate from a decreased intracranial compliance [ 13 , 25 – 29 ] but could alternatively be explained by CSF hypersecretion, a potential mechanism generally neglected in the pathogenesis of hydrocephalus.…”

Section: Introductionmentioning

confidence: 99%

Elevated CSF inflammatory markers in patients with idiopathic normal pressure hydrocephalus do not promote NKCC1 hyperactivity in rat choroid plexus

Lolansen

Rostgaard

Andreassen

et al. 2021

Fluids Barriers CNS

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Background Idiopathic normal pressure hydrocephalus (iNPH) is a potentially reversible neurological condition of unresolved etiology characterized by a clinical triad of symptoms; gait disturbances, urinary incontinence, and cognitive deterioration. In the present study, we aimed to elucidate the molecular coupling between inflammatory markers and development of iNPH and determine whether inflammation-induced hyperactivity of the choroidal Na+/K+/2Cl− cotransporter (NKCC1) that is involved in cerebrospinal fluid (CSF) secretion could contribute to the iNPH pathogenesis. Methods Lumbar CSF samples from 20 iNPH patients (10 with clinical improvement upon CSF shunting, 10 without clinical improvement) and 20 elderly control subjects were analyzed with the novel proximity extension assay technique for presence of 92 different inflammatory markers. RNA-sequencing was employed to delineate choroidal abundance of the receptors for the inflammatory markers found elevated in the CSF from iNPH patients. The ability of the elevated inflammatory markers to modulate choroidal NKCC1 activity was determined by addition of combinations of rat version of these in ex vivo experiments on rat choroid plexus. Results 11 inflammatory markers were significantly elevated in the CSF from iNPH patients compared to elderly control subjects: CCL28, CCL23, CCL3, OPG, CXCL1, IL-18, IL-8, OSM, 4E-BP1, CXCL6, and Flt3L. One inflammatory marker, CDCP1, was significantly decreased in iNPH patients compared to control subjects. None of the inflammatory markers differed significantly when comparing iNPH patients with and without clinical improvement upon CSF shunting. All receptors for the elevated inflammatory markers were expressed in the rat and human choroid plexus, except CCR4 and CXCR1, which were absent from the rat choroid plexus. None of the elevated inflammatory markers found in the CSF from iNPH patients modulated the choroidal NKCC1 activity in ex vivo experiments on rat choroid plexus. Conclusion The CSF from iNPH patients contains elevated levels of a subset of inflammatory markers. Although the corresponding inflammatory receptors are, in general, expressed in the choroid plexus of rats and humans, their activation did not modulate the NKCC1-mediated fraction of choroidal CSF secretion ex vivo. The molecular mechanisms underlying ventriculomegaly in iNPH, and the possible connection to inflammation, therefore remains to be elucidated.

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Section: Introductionmentioning

confidence: 99%

Elevated CSF inflammatory markers in patients with idiopathic normal pressure hydrocephalus do not promote NKCC1 hyperactivity in rat choroid plexus

Lolansen

Rostgaard

Andreassen

et al. 2021

Fluids Barriers CNS

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“…A great degree of variation has been found in CSF flow parameters depending on the study: the upper limit of the flow rate ranges from 18 to 24 ml/min [ 2 , 3 , 11 ], and the upper limit of peak flow velocity from 9 to 10 cm/s [ 24 , 25 ]. Hence, the raw CSF flow values seem not to be a reliable and strong diagnostic criteria for hydrocephalus.…”

Section: Discussionmentioning

confidence: 99%

The oscillatory flow of the cerebrospinal fluid in the Sylvian aqueduct and the prepontine cistern measured with phase contrast MRI in children with hydrocephalus—a preliminary report

et al. 2018

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IntroductionRecognizing patients with ventriculomegaly who are at risk of developing acute hydrocephalus presents a challenge for the clinician. The association between disturbed cerebrospinal fluid flow (CSF) and impaired brain compliance may play a role in the pathogenesis of hydrocephalus. Phase contrast MRI is a noninvasive technique which can be used to assess CSF parameters. The aim of the work is to evaluate the effectiveness of phase contrast MRI in recognizing patients at risk of acute hydrocephalus, based on measuring the pulsatile CSF flow parameters in the Sylvian aqueduct and prepontine cistern in children with ventriculomegaly.AimThe aim of the work is to characterize the parameters of cerebrospinal fluid (CSF) flow in the Sylvian aqueduct and prepontine cistern in children with ventriculomegaly with regard to patient age and symptoms. We hypothesize that the relationship between CSF flow parameters in these two regions will vary according to analyzed factors and it will allow to recognize children at risk of hydrocephalus.Materials and methodsA group of 26 children with ventriculomegaly (five girls and 21 boys) underwent phase contrast MRI examinations (Philips 3T Achieva with Q-flow integral application). Amplitudes of average and peak velocities of the CSF flow through the Sylvian aqueduct and prepontine cistern were used to calculate ratios of oscillation and peak velocities, respectively. The relationship between the oscillation coefficient, the peak velocity coefficient, and stroke volume was then assessed in accordance with age and clinical symptoms.ResultsThe peak velocity coefficient was significantly higher in patients with hyper-oscillating flow through the Sylvian aqueduct (3.04 ± 3.37 vs. 0.54 ± 0.28; p = 0.0094). Moreover, these patients tended to develop symptoms more often (p = 0.0612). No significant age-related changes were observed in CSF flow parameters.ConclusionPhase contrast MRI is a useful tool for noninvasive assessment of CSF flow parameters. The application of coefficients instead of direct values seems to better represent hemodynamic conditions in the ventricular system. However, further studies are required to evaluate their clinical significance and normal limits.

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“…On the other hand, there are various PC MRI studies that have shown that the CSF flow in iNPH patients is in a hyper-dynamic state, which is in accordance with our results. Specifically, it has been shown that mean CSF flow is greater in iNPH but not AD patients compared to healthy controls [ 7 , 10 ], CSF motion increases in iNPH patients [ 16 ], and stroke volume increases in iNPH patients [ 9 , 17 , 18 ]. However, it is not currently possible to use markers such as stroke volume [ 8 ] to distinguish between iNPH and AD.…”

Section: Discussionmentioning

confidence: 99%

“…CSF motion in elderly groups has only been investigated in a small number of studies and there is no consensus on the characteristics of CSF motion in AD patients [ 3 , 7 , 8 ]. In the iNPH study, CSF motion appears to be hyper dynamic [ 3 , 9 , 10 ]. The aim of this study was to compare the CSF dynamics of healthy elderly volunteers with those of AD and iNPH patients.…”

Section: Introductionmentioning

confidence: 99%

Hyperdynamic CSF motion profiles found in idiopathic normal pressure hydrocephalus and Alzheimer’s disease assessed by fluid mechanics derived from magnetic resonance images

Takizawa

Matsumae

Hayashi

et al. 2017

Fluids Barriers CNS

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BackgroundMagnetic resonance imaging (MRI) does not only ascertain morphological features, but also measures physiological properties such as fluid velocity or pressure gradient. The purpose of this study was to investigate cerebrospinal fluid (CSF) dynamics in patients with morphological abnormalities such as enlarged brain ventricles and subarachnoid spaces. We used a time-resolved three dimensional phase contrast (3D-PC) MRI technique to quantitatively evaluate CSF dynamics in the Sylvian aqueduct of healthy elderly individuals and patients with either idiopathic normal pressure hydrocephalus (iNPH) or Alzheimer’s disease (AD) presenting with ventricular enlargement.MethodsNineteen healthy elderly individuals, ten iNPH patients, and seven AD patients (all subjects ≥ 60 years old) were retrospectively evaluated 3D-PC MRI. The CSF velocity, pressure gradient, and rotation in the Sylvian aqueduct were quantified and compared between the three groups using Kolmogorov–Smirnov and Mann–Whitney U tests.ResultsThere was no statistically significant difference in velocity among the three groups. The pressure gradient was not significantly different between the iNPH and AD groups, but was significantly different between the iNPH group and the healthy controls (p < 0.001), and similarly, between the AD group and the healthy controls (p < 0.001). Rotation was not significantly different between the iNPH and AD groups, but was significantly different between the iNPH group and healthy controls (p < 0.001), and similarly, between the AD group and the healthy controls (p < 0.001).ConclusionsQuantitative analysis of CSF dynamics with time resolved 3D-PC MRI revealed differences and similarities in the Sylvian aqueduct between healthy elderly individuals, iNPH patients, and AD patients. The results showed that CSF motion is in a hyperdynamic state in both iNPH and AD patient groups compared to healthy elderly individuals, and that iNPH patients and AD patients display similar CSF motion profiles.

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Normal pressure hydrocephalus versus atrophic dilatation to distinguish and predict the benefits of surgical intervention with a phase-contrast MRI technique

Cited by 5 publications

References 19 publications

Elevated CSF inflammatory markers in patients with idiopathic normal pressure hydrocephalus do not promote NKCC1 hyperactivity in rat choroid plexus

Elevated CSF inflammatory markers in patients with idiopathic normal pressure hydrocephalus do not promote NKCC1 hyperactivity in rat choroid plexus

The oscillatory flow of the cerebrospinal fluid in the Sylvian aqueduct and the prepontine cistern measured with phase contrast MRI in children with hydrocephalus—a preliminary report

Hyperdynamic CSF motion profiles found in idiopathic normal pressure hydrocephalus and Alzheimer’s disease assessed by fluid mechanics derived from magnetic resonance images

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