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Research ArticleSpine

Resisted Inspiration: A New Technique to Aid in the Detection of CSF-Venous Fistulas

I.T. Mark, M.R. Amans, V.N. Shah, K.H. Narsinh, M.T. Caton, S. Teixeira and W.P. Dillon
American Journal of Neuroradiology October 2022, 43 (10) 1544-1547; DOI: https://doi.org/10.3174/ajnr.A7636
I.T. Mark
aFrom the Department of Radiology and Biomedical Imaging (I.T.M., M.R.A., V.N.S., K.H.N., M.T.C., S.T, W.P.D.), University of California, San Francisco, San Francisco, California
bDepartment of Radiology (I.T.M.), Mayo Clinic, Rochester, Minnesota
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M.R. Amans
aFrom the Department of Radiology and Biomedical Imaging (I.T.M., M.R.A., V.N.S., K.H.N., M.T.C., S.T, W.P.D.), University of California, San Francisco, San Francisco, California
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V.N. Shah
aFrom the Department of Radiology and Biomedical Imaging (I.T.M., M.R.A., V.N.S., K.H.N., M.T.C., S.T, W.P.D.), University of California, San Francisco, San Francisco, California
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K.H. Narsinh
aFrom the Department of Radiology and Biomedical Imaging (I.T.M., M.R.A., V.N.S., K.H.N., M.T.C., S.T, W.P.D.), University of California, San Francisco, San Francisco, California
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M.T. Caton
aFrom the Department of Radiology and Biomedical Imaging (I.T.M., M.R.A., V.N.S., K.H.N., M.T.C., S.T, W.P.D.), University of California, San Francisco, San Francisco, California
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S. Teixeira
aFrom the Department of Radiology and Biomedical Imaging (I.T.M., M.R.A., V.N.S., K.H.N., M.T.C., S.T, W.P.D.), University of California, San Francisco, San Francisco, California
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W.P. Dillon
aFrom the Department of Radiology and Biomedical Imaging (I.T.M., M.R.A., V.N.S., K.H.N., M.T.C., S.T, W.P.D.), University of California, San Francisco, San Francisco, California
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  • FIG 1.
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    FIG 1.

    SVC venous pressure changes with 4 different techniques relative to the SVC venous pressure while breathing at rest. End-resisted inspiration leads to the greatest drop in pressure, which is far greater than with normal inspiration.

  • FIG 2.
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    FIG 2.

    CSF pressure changes with 4 different techniques relative to the CSF pressure while breathing at rest. CSF pressure increased the most with end-resisted inspiration, which was even greater compared with the Valsalva maneuver.

Tables

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    Table 1:

    Individual patient demographics and SVC manometry readings in 4 patients who underwent a catheter venogram

    Venous Pressure (mm Hg)
    PatientAge (yr)/SexIndicationBMIRest PressureValsalvaNormal InspirationMid-Resisted InspirationEnd-Resisted Inspiration
    157/FIIH34.5311–1–8–16
    263/MPulsatile tinnitus24.8127–1–15–26
    369/FPulsatile tinnitus31.6225–6–15–31
    452/FIIH42.610258–2–11
    • Note:—F indicates female; M, male; BMI, body mass index.

    • View popup
    Table 2:

    Individual patient demographics and lumbar CSF manometry readings in 4 patients who underwent a CT-guided LP

    CSF Pressure (cm H20)
    PatientAge (yr)/SexIndicationBMIRest PressureValsalvaNormal InspirationMid-Resisted InspirationEnd-Resisted Inspiration
    169/FPrior idiopathic leptomeningeal enhancement19.61315141517
    245/FNew-onset psychosis27.93340383941
    375/MIntrathecal chemotherapy24.207112
    459/MMetastatic lung cancer27.32751016
    • Note:—F indicates female; M, male; BMI, body mass index.

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American Journal of Neuroradiology: 43 (10)
American Journal of Neuroradiology
Vol. 43, Issue 10
1 Oct 2022
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I.T. Mark, M.R. Amans, V.N. Shah, K.H. Narsinh, M.T. Caton, S. Teixeira, W.P. Dillon
Resisted Inspiration: A New Technique to Aid in the Detection of CSF-Venous Fistulas
American Journal of Neuroradiology Oct 2022, 43 (10) 1544-1547; DOI: 10.3174/ajnr.A7636

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Resisted Inspiration for CSF-Venous Fistulas
I.T. Mark, M.R. Amans, V.N. Shah, K.H. Narsinh, M.T. Caton, S. Teixeira, W.P. Dillon
American Journal of Neuroradiology Oct 2022, 43 (10) 1544-1547; DOI: 10.3174/ajnr.A7636
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