Document Detail


The reversibility of reduced cortical vein compliance in normal-pressure hydrocephalus following shunt insertion.
MedLine Citation:
PMID:  12592485     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Superficial cortical venous compression secondary to alterations in craniospinal compliance is implicated in the pathogenesis of normal pressure hydrocephalus (NPH). A reduction in the pulsation in the outflow of the cortical veins would be expected to occur following compression of these veins and this has been shown in NPH. If cortical vein compression is a causative factor in NPH, it would be expected that cortical vein compliance as measured by pulsatility would be significantly altered by a curative procedure i.e. shunt tube insertion. My purpose is to compare the blood flow pulsatility characteristics in a group of patients with NPH before and after shunt tube insertion. I initially studied 18 subjects without pathology with MRI flow quantification studies of the cerebral arteries and veins to define the range of normality. The main study involved 18 patients with idiopathic dementia and mild leukoaraiosis who served as controls and seven patients with NPH studied before and after shunt insertion. Arterial, superior sagittal and straight sinus pulsatility was not significantly different between the patients with idiopathic dementia and those NPH patients before or after shunting. Cortical vein pulsatility before shunting in the patients with NPH was 43% lower than in those with idiopathic dementia ( P=0.006). Following shunting, cortical vein pulsatility increased by 186% ( P=0.007). There is thus reduced compliance in cortical veins in NPH which is significantly increased in patients who respond to insertion of a shunt tube. These findings suggest that reversible elevation in cortical vein pressure and reversal of the normal absorption pathway for cerebrospinal fluid may be behind the pathophysiology of NPH.
Authors:
G A Bateman
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2003-01-16
Journal Detail:
Title:  Neuroradiology     Volume:  45     ISSN:  0028-3940     ISO Abbreviation:  Neuroradiology     Publication Date:  2003 Feb 
Date Detail:
Created Date:  2003-02-19     Completed Date:  2003-04-29     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1302751     Medline TA:  Neuroradiology     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  65-70     Citation Subset:  IM    
Affiliation:
Department of Medical Imaging, John Hunter Hospital, Locked Bag 1, Newcastle Region Mail Centre, 2310 Australia. grant.bateman@hunter.health.nsw.gov.au
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Cerebral Cortex / blood supply*
Cerebrospinal Fluid Shunts*
Cerebrovascular Circulation*
Female
Humans
Hydrocephalus, Normal Pressure / physiopathology*,  surgery
Magnetic Resonance Imaging
Male
Middle Aged
Pulsatile Flow
Veins / physiopathology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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