ABSTRACT
BACKGROUND: Idiopathic normal pressure hydrocephalus (iNPH) is a cause of dementia that can be reversed when treated timely with cerebrospinal fluid (CSF) diversion. Understanding CSF dynamics throughout the development of hydrocephalus is crucial to identify prognostic markers to estimate benefit/risk to shunts. OBJECTIVE: To explore the cerebral aqueduct CSF flow dynamics with phase-contrast magnetic resonance imaging (MRI) in a novel rodent model of adult chronic communicating hydrocephalus. METHODS: Kaolin was injected into the subarachnoid space at the convexities in Sprague-Dawley adult rats. 11.7-T Bruker MRI was used to acquire T2-weighted images for anatomic identification and phase-contrast MRI at the cerebral aqueduct. Aqueductal stroke volume (ASV) results were compared with the ventricular volume (VV) at 15, 60, 90, and 120 days. RESULTS: Significant ventricular enlargement was found in kaolin-injected animals at all times (P < 0.001). ASV differed between cases and controls/shams at every time point (P = 0.004, 0.001, 0.001, and <0.001 at 15, 60, 90, and 120 days, respectively). After correlation between the ASV and the VV, there was a significant correlation at 15 (P = 0.015), 60 (P = 0.001), 90 (P < 0.001), and 120 days. Moreover, there was a significant positive correlation between the VV expansion and the aqueductal CSF stroke between 15 and 60 days. CONCLUSIONS: An initial active phase of rapid ventricular enlargement shows a strong correlation between the expansion of the VV and the increment in the ASV during the first 60 days, followed by a second phase with less ventricular enlargement and heterogeneous behavior in the ASV. Further correlation with complementary data from intracranial pressure and histologic/microstructural brain parenchyma assessments are needed to better understand the ASV variations after 60 days.
Subject(s)
Cerebral Aqueduct/physiopathology , Cerebrospinal Fluid , Disease Models, Animal , Hydrocephalus/physiopathology , Hydrodynamics , Animals , Cerebral Aqueduct/diagnostic imaging , Cerebrospinal Fluid/diagnostic imaging , Contrast Media , Disease Progression , Hydrocephalus/diagnostic imaging , Kaolin , Magnetic Resonance Imaging , Organ Size , Rats, Sprague-DawleyABSTRACT
El neumoencéfalo implica una comunicación entre la cavidad intracraneana y el exterior. Es por esto que la etiología más frecuente son los traumatismos craneanos. La presencia de un neumoencéfalo en un paciente con una válvula ventrículo peritoneal es sorprendente y a primera vista inexplicable. De las múltiples complicaciones descritas con las derivaciones ventrículo-peritoneales, ésta ha sido comunicada en la literatura sólo en 9 casos. Se describe un paciente con acueductoestenosis y válvula ventrículo peritoneal que presentó un neumoencéfalo. Se comenta la patogenia y el tratamiento más adecuado de acuerdo a la revisión de la literatura
Subject(s)
Humans , Male , Adolescent , Anastomosis, Surgical/adverse effects , Cerebral Aqueduct/physiopathology , Pneumocephalus/etiology , Cerebral Ventricles/physiopathologyABSTRACT
A 28-year-old man with a history of congenital hydrocephalus due to aqueductal stenosis shunted at 45 days of age is presented. At age 4 years the valve had to be removed because of septicemia. Twenty-three years later he developed parkinsonian signs and abnormal, involuntary rhythmic contractions of the eyelids. The latter were elicited on gentle eye closure. Parkinsonism promptly improved after ventriculoperitoneal shunting, but blepharoclonus persisted unchanged.