AJDRAJNR - American Journal of Neuroradiology

Published ahead of print on October 9, 2007
doi: 10.3174/ajnr.A0785
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Changes in Aqueductal CSF Stroke Volume and Progression of Symptoms in Patients With Unshunted Idiopathic Normal Pressure Hydrocephalus

A. Scollatoa, R. Tenenbauma, G. Bahld, M. Celerinib, B. Salanic and N. Di Lorenzoa

a Department of Neurosurgery, Geriatric Agency, University of Florence, Florence, Italy
b Department of Radiology, Geriatric Agency, University of Florence, Florence, Italy
c Emergency Department, Geriatric Agency, University of Florence, Florence, Italy
d Department of Radiology, University of California, San Diego, San Diego, California


Figure 1
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  		Fig 1. Ventricular enlargement in MR image of a patient with NPH with a positive Evans Index.


Figure 2
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  		Fig 2. PCCMR imaging CSF dynamic study in a 74-year-old patient with NPH. A, Midline sagittal T1-weighted MR imaging is used to graphically describe the phase-contrast cine series. The section is placed at the level of the inferior colliculus, perpendicular to a line drawn through the distal aqueduct. B, Axial section in which region of interest is drawn as close as possible to the aqueduct border. C, Respective absolute values of CSF during 16 cardiac phases are reported on the graph. The flow plot demonstrates sinusoidal pattern of flow where negative values represent aqueductal systolic CSF volume (microliter) outflow and positive values represent diastolic CSF volume inflow.


Figure 3
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  		Fig 3. Changes in SV values at 6, 12, 18, and 24 months for each of the 9 patients.


Figure 4
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  		Fig 4. Changes in SV values (Table 1) standardized for the estimated onset of NPH, as per the reported first symptoms of NPH.


Figure 5
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  		Fig 5. Proposed model demonstrating SV changes in NPH. A, In healthy subjects, expansion of the cerebral hemispheres occurs both outward and inward. The outward expansion produces venous blood outflow as a result of compression on the cortical veins. Inward expansion produces flow of CSF into the aqueduct as a result of compression of the lateral and third ventricles. B, In communicating hydrocephalus, the brain has already expanded outward during diastole, compressing the cortical veins. However, during systole, with arterial blood entering, the systolic expansion is directed inwards, resulting in a much greater SV in the aqueduct. C, Progressive ischemia and a reduction of arterial inflow results in a decreased "ventricular CSF pump."





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X