Assessment of hemo- and cerebrospinal fluid dynamics disorders in idiopathic normal pressure hydrocephalus according to MRI data: a prospective study

INTRODUCTION: Idiopathic normal pressure hydrocephalus (NPH) is a condition characterized by enlargement of the cerebral ventricles and an isolated disturbance of cerebrospinal fluid dynamics, the etiology and pathogenesis of which are still not fully determined.

OBJECTIVE: To evaluate changes in hemo- and cerebrospinal fluid dynamics in idiopathic normal pressure hydrocephalus according to phase-contrast MRI data.

MATERIALS AND METHODS: Three groups of subjects were formed: patients with NPH (12 people), elderly volunteers with atrophic ventriculomegaly (15 people), a group of healthy volunteers (15 people). For each subject, the data from a routine MRI study, the volumes of gray, white matter and cerebrospinal fluid were assessed, and the volume-velocity characteristics of CSF and blood flows at several levels were calculated.

Statistics: For quantitative indicators of cerebrospinal fluid dynamics, the median (Me), 25% and 75% percentiles, and interquartile range were calculated. An intergroup assessment of the significance of differences was carried out using the Mann-Whitney U test and nonparametric multivariate analysis of variance MANOVA.

RESULTS: Individual neuroimaging markers of IGT were determined, as well as an increase in the volume-velocity characteristics of CSF flow at the level of the cerebral aqueduct (p<0.01, with a predominance of the retrograde component) in comparison with the control group and patients with atrophic ventriculomegaly. Multidirectional changes in the volume of intracranial venous outflow were revealed in the study groups: in patients with IGT – a decrease in outflow along the straight sinus by 1.4 times (p<0.01), in patients with atrophic ventriculomegaly – a decrease in outflow along the superior sagittal sinus by 1.3 times (p<0.05).

DISCUSSION: The data obtained show a significant impairment of cerebrospinal fluid dynamics in patients with NPH, in contrast to elderly volunteers with age-related atrophy and replacement expansion of the cerebrospinal fluid spaces at the level of the brain aqueduct, and also indicates the importance of the venous link in maintaining intracranial volumetric interactions.

CONCLUSION: The combined use of a routine protocol and phase-contrast MRI techniques made it possible to identify a number of neuroimaging, hemo- and CSF dynamic changes in patients with NPH in comparison with healthy volunteers, and also, most importantly, with patients of comparable age with the presence of replacement ventriculomegaly against the background of atrophy.

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