Title:Intracranial Fluid Dynamics Changes in Idiopathic Intracranial Hypertension: Pre and Post Therapy
Volume: 15
Issue: 2
Author(s): Nivedita Agarwal*, Christian Contarino, Nicola Limbucci, Laura Bertazzi and Eleuterio Toro
Affiliation:
- Section of Radiology, Hospital Santa Maria del Carmine, Rovereto, TN,Italy
Keywords:
Idiopathic intracranial hypertension, fluid mechanics, phase contrast-cine magnetic resonance imaging, dural venous
stenosis, papilledema, neurovascular, venous stent.
Abstract: Objective: Idiopathic Intracranial Hypertension (IIH) is a condition of unknown etiology
frequently associated with dural sinus stenosis. There is emerging evidence that venous sinus
stenting is an effective treatment. We use phase contrast cine MRI to observe changes in flow dynamics
of multiple intracranial fluids and their response to different treatments in a patient with
IIH.
Methods: We quantified the following parameters at the level of the aqueduct of Sylvius and the
cervical C2C3: Cerebrospinal Fluid (CSF), arterial and venous flow; CSF velocity amplitude;
artero-venous delay (AVD); artero-CSF delay and percentage of venous outflow normalized to total
arterial inflow (tIJV/tA). Analyses were run before Lumbar Puncture (LP) (A), after LP (B), after
medical therapy (C) and after venous stent placements deployed at two separate times (D and
E).
Results: AVD and tIJV/tA improved only after CSF removal and after stent placements. CSF velocity
amplitude remained elevated. Arterial flow profile showed a dramatic reduction after LP
with improvement in mean venous flow. This report is the first to demonstrate interactive changes
in intracranial fluid dynamics that occur before and after different therapeutic interventions in IIH.
Conclusion: The data provide valuable information regarding changes in different fluid compartments
suggesting a profound redistribution of pressures along fluid compartments after different
treatments. We discuss how increased intracranial venous blood could be “tumoral” in IIH and facilitating
its outflow could be therapeutic.
