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Cerebrospinal fluid and blood flow patterns in idiopathic normal pressure hydrocephalus
Umeå University, Faculty of Medicine, Department of Radiation Sciences. Umeå University, Faculty of Science and Technology, Centre for Biomedical Engineering and Physics (CMTF).
Umeå University, Faculty of Medicine, Department of Radiation Sciences. Umeå University, Faculty of Science and Technology, Centre for Biomedical Engineering and Physics (CMTF).
Umeå University, Faculty of Medicine, Department of Radiation Sciences. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
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2017 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 135, no 5, 576-584 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: Increased aqueduct cerebrospinal fluid (CSF) flow pulsatility and, recently, a reversed CSF flow in the aqueduct have been suggested as hallmarks of idiopathic normal pressure hydrocephalus (INPH). However, these findings have not been adequately confirmed. Our objective was to investigate the flow of blood and CSF in INPH, as compared to healthy elderly, in order to clarify which flow parameters are related to the INPH pathophysiology.

Materials and Methods: Sixteen INPH patients (73 years) and 35 healthy subjects (72 years) underwent phase-contrast magnetic resonance imaging (MRI). Measurements included aqueduct and cervical CSF flow, total arterial inflow (tCBF; i.e. carotid + vertebral arteries), and internal jugular vein flow. Flow pulsatility, net flow, and flow delays were compared (multiple linear regression, correcting for sex and age).

Results: Aqueduct stroke volume was higher in INPH than healthy (148±95 vs 90±50 mL, P<.05). Net aqueduct CSF flow was similar in magnitude and direction. The cervical CSF stroke volume was lower (P<.05). The internal carotid artery net flow was lower in INPH (P<.05), although tCBF was not. No differences were found in internal jugular vein flow or flow delays.

Conclusions: The typical flow of blood and CSF in INPH was mainly characterized by increased CSF pulsatility in the aqueduct and reduced cervical CSF pulsatility. The direction of mean net aqueduct CSF flow was from the third to the fourth ventricle. Our findings may reflect the altered distribution of intracranial CSF volume in INPH, although the causality of these relationships is unclear.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2017. Vol. 135, no 5, 576-584 p.
Keyword [en]
aqueduct flow, cerebral blood flow, cerebrospinal fluid, dementia, normal pressure hydrocephalus, phase-contrast magnetic resonance imaging
National Category
Neurology
Identifiers
URN: urn:nbn:se:umu:diva-131143DOI: 10.1111/ane.12636ISI: 000400156400012PubMedID: 27388230OAI: oai:DiVA.org:umu-131143DiVA: diva2:1071860
Funder
Swedish Research Council, 221-2011-5216
Available from: 2017-02-06 Created: 2017-02-06 Last updated: 2017-05-30Bibliographically approved

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Qvarlander, SaraAmbarki, KhalidWåhlin, AndersJacobsson, JohanBirgander, RichardMalm, JanEklund, Anders
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Department of Radiation SciencesCentre for Biomedical Engineering and Physics (CMTF)Umeå Centre for Functional Brain Imaging (UFBI)Clinical Neuroscience
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CiteExportLink to record
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