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Tomita T, Yuminaga H, Takashima H, Masuda T, Mano T. Image Findings as Predictors of Fall Risk in Patients with Cerebrovascular Disease. Brain Sci 2023; 13:1690. [PMID: 38137138 PMCID: PMC10742017 DOI: 10.3390/brainsci13121690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
This study examined computed tomography findings in patients with cerebrovascular disease and determined predictors for falls. Images of the head were divided into 13 regions, and the relationships between computed tomography findings and the presence or absence of falls were investigated. A total of 138 patients with cerebrovascular disease (66% men, aged 73.8 ± 9.6 years) were included. A comparison between the fall and non-fall groups revealed a significant difference in the total functional independence measure scores and imaging findings at admission. Logistic regression analysis showed that the thalamus (p < 0.001), periventricular lucency (p < 0.001), lateral hemisphere room enlargement (p < 0.05), and age (p < 0.05) were related to the presence or absence of falls. For the 42 patients with cerebral hemorrhage, the thalamus (p < 0.01), periventricular lucency (p < 0.05), lateral ventricle vicinity (p < 0.05), and posterior limb of the internal capsule (p < 0.05) were extracted as factors related to the presence or absence of falls. For the 96 patients with cerebral infarction, the thalamus (p < 0.001), periventricular lucency (p < 0.01), and anterior limb of the internal capsule (p < 0.05) were extracted as factors related to the presence or absence of falls. This study found a relationship between the thalamus, lateral ventricle enlargement, periventricular lucency, and falls. Fall prognosis can potentially be predicted from computed tomography findings at admission.
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Affiliation(s)
- Tatsuya Tomita
- Department of Rehabilitation, Nara Prefectural General Medical Center, Nara 630-8054, Japan; (T.T.); (H.T.); (T.M.)
| | - Hisanori Yuminaga
- Department of Physical Therapy, Kansai Vocational College of Medicine, Osaka 558-0011, Japan;
| | - Hideki Takashima
- Department of Rehabilitation, Nara Prefectural General Medical Center, Nara 630-8054, Japan; (T.T.); (H.T.); (T.M.)
| | - Takashi Masuda
- Department of Rehabilitation, Nara Prefectural General Medical Center, Nara 630-8054, Japan; (T.T.); (H.T.); (T.M.)
| | - Tomoo Mano
- Department of Rehabilitation, Nara Prefectural General Medical Center, Nara 630-8054, Japan; (T.T.); (H.T.); (T.M.)
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Li Z, Zhang H, Hu G, Zhang G. Post-traumatic hydrocephalus: An overview of classification, diagnosis, treatment, and post-treatment imaging evaluation. Brain Res Bull 2023; 205:110824. [PMID: 37995869 DOI: 10.1016/j.brainresbull.2023.110824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 11/02/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023]
Abstract
The syndrome of post-traumatic hydrocephalus (PTH) has been recognized since Dandy's report in 1914. The pathogenesis of PTH has not been fully clarified. At present, it is believed that the obstacles of cerebrospinal fluid (CSF) secretion, absorption and circulation pathways are the reasons for the development of PTH. However, recent studies have also suggested that the osmotic pressure load of CSF and the pathological changes of CSF dynamics are caused by the development of hydrocephalus. Therefore, a better understanding of the definition, classification, diagnostic criteria, treatment, and evaluation of post-treatment effects of PTH is critical for the effective prevention and treatment of PTH. In this paper, we reviewed the classification and diagnosis of PTH and focused on the treatment and the imaging evaluation of post-treatment effects of PTH. This review might provide a judgment criterion for diagnosis of PTH and a basis for the effective prevention and treatment of PTH in the future.
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Affiliation(s)
- Zhao Li
- Department of Neurosurgery, Shengzhou Hospital of Traditional Chinese Medicine, Shengzhou City, Zhejiang Province 312400, China
| | - Han Zhang
- Department of Neurosurgery, Shengzhou People's Hospital, Shengzhou City, Zhejiang Province 312400, China
| | - Guojie Hu
- Department of Neurosurgery, Shengzhou Hospital of Traditional Chinese Medicine, Shengzhou City, Zhejiang Province 312400, China
| | - Guohai Zhang
- Department of Neurosurgery, Shengzhou Hospital of Traditional Chinese Medicine, Shengzhou City, Zhejiang Province 312400, China.
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3
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Kumaria A, Macarthur DC, Kirkman MA. Periventricular lucency in hydrocephalus: a glymphatic viewpoint. Childs Nerv Syst 2023; 39:1113-1114. [PMID: 37046103 DOI: 10.1007/s00381-023-05953-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/05/2023] [Indexed: 04/14/2023]
Affiliation(s)
- Ashwin Kumaria
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, UK.
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Yang PH, Almgren-Bell A, Gu H, Dowling AV, Pugazenthi S, Mackey K, Dupépé EB, Strahle JM. Etiology- and region-specific characteristics of transependymal cerebrospinal fluid flow. J Neurosurg Pediatr 2022; 30:437-447. [PMID: 35962970 PMCID: PMC9990373 DOI: 10.3171/2022.7.peds2246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 07/01/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Transependymal flow (TEF) of CSF, often delineated as T2-weighted hyperintensity adjacent to the lateral ventricles on MRI, is a known imaging finding, usually in the setting of CSF flow disturbances. Specific radiological features of TEF and their relationships with clinical markers of hydrocephalus and underlying disease pathology are not known. Here, the authors describe the radiological features and clinical associations of TEF with implications for CSF circulation in the setting of intracranial pathology. METHODS After obtaining IRB review and approval, the authors reviewed the radiological records of all patients who underwent intracranial imaging with CT or MRI at St. Louis Children's Hospital, St. Louis, Missouri, between 2008 and 2019 to identify individuals with TEF. Then, under direct review of imaging, TEF pattern, degree, and location and underlying pathology and other radiological and clinical features pertaining to CSF circulation and CSF disturbances were noted. RESULTS TEF of CSF was identified in 219 patients and was most prevalent in the setting of neoplasms (72%). In 69% of the overall cohort, TEF was seen adjacent to the anterior aspect of the frontal horns and the posterior aspect of the occipital horns of the lateral ventricles, and nearly half of these patients also had TEF dorsal to the third ventricle near the splenium of the corpus callosum. This pattern was independently associated with posterior fossa medulloblastoma when compared with pilocytic astrocytoma (OR 4.75, 95% CI 1.43-18.53, p = 0.0157). Patients with congenital or neonatal-onset hydrocephalus accounted for 13% of patients and were more likely to have TEF circumferentially around the ventricles without the fronto-occipital distribution. Patients who ultimately required permanent CSF diversion surgery were more likely to have the circumferential TEF pattern, a smaller degree of TEF, and a lack of papilledema at the time of CSF diversion surgery. CONCLUSIONS CSF transmigration across the ependyma is usually restricted to specific periventricular regions and is etiology specific. Certain radiological TEF characteristics are associated with tumor pathology and may reflect impaired or preserved ependymal fluid handling and global CSF circulation. These findings have implications for TEF as a disease-specific marker and in understanding CSF handling within the brain.
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Affiliation(s)
- Peter H. Yang
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis
| | - Alison Almgren-Bell
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis
| | - Hongjie Gu
- Division of Biostatistics, Washington University in St. Louis, Missouri
| | - Anna V. Dowling
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis
| | - Sangami Pugazenthi
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis
| | - Kimberly Mackey
- Department of Neurological Surgery, Children’s Hospital of The King’s Daughters, Norfolk, Virginia
| | - Esther B. Dupépé
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis
| | - Jennifer M. Strahle
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis
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Transmantle and transvenous pressure gradients in cerebrospinal fluid disorders. Neurosurg Rev 2021; 45:305-315. [PMID: 34390441 DOI: 10.1007/s10143-021-01622-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/02/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
Hydrocephalus is the symptomatic endpoint of a variety of disease processes. Simple hydrodynamic models have failed to explain the entire spectrum of cerebrospinal fluid (CSF) disorders. Physical principles argue that for ventricles to expand, they must be driven by a force, Fishman's transmantle pressure gradient (TMPG). However, the literature to date, reviewed herein, is heterogenous and fails to consistently measure a TMPG. The venous system, like CSF, traverses the cerebral mantle, and thus analogous transparenchymal and transvenous pressure gradients have been described, reliant on the differential haemodynamics of the deep and superficial venous systems. Interpreting CSF disorders through these models provides new insights into the possible pathophysiological mechanisms underlying these diseases. However, until more sophisticated testing is performed, these models should remain heuristics.
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Vardakis JC, Chou D, Guo L, Ventikos Y. Exploring neurodegenerative disorders using a novel integrated model of cerebral transport: Initial results. Proc Inst Mech Eng H 2020; 234:1223-1234. [PMID: 33078663 PMCID: PMC7675777 DOI: 10.1177/0954411920964630] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The neurovascular unit (NVU) underlines the complex and symbiotic relationship between brain cells and the cerebral vasculature, and dictates the need to consider both neurodegenerative and cerebrovascular diseases under the same mechanistic umbrella. Importantly, unlike peripheral organs, the brain was thought not to contain a dedicated lymphatics system. The glymphatic system concept (a portmanteau of glia and lymphatic) has further emphasized the importance of cerebrospinal fluid transport and emphasized its role as a mechanism for waste removal from the central nervous system. In this work, we outline a novel multiporoelastic solver which is embedded within a high precision, subject specific workflow that allows for the co-existence of a multitude of interconnected compartments with varying properties (multiple-network poroelastic theory, or MPET), that allow for the physiologically accurate representation of perfused brain tissue. This novel numerical template is based on a six-compartment MPET system (6-MPET) and is implemented through an in-house finite element code. The latter utilises the specificity of a high throughput imaging pipeline (which has been extended to incorporate the regional variation of mechanical properties) and blood flow variability model developed as part of the VPH-DARE@IT research platform. To exemplify the capability of this large-scale consolidated pipeline, a cognitively healthy subject is used to acquire novel, biomechanistically inspired biomarkers relating to primary and derivative variables of the 6-MPET system. These biomarkers are shown to capture the sophisticated nature of the NVU and the glymphatic system, paving the way for a potential route in deconvoluting the complexity associated with the likely interdependence of neurodegenerative and cerebrovascular diseases. The present study is the first, to the best of our knowledge, that casts and implements the 6-MPET equations in a 3D anatomically accurate brain geometry.
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Affiliation(s)
- John C Vardakis
- CISTIB Centre for Computational Imaging and Simulation Technologies in Biomedicine, School of Computing, University of Leeds, Leeds, UK
| | - Dean Chou
- Department of Biomedical Engineering, National Cheng Kung University, Tainan City, Taiwan
| | - Liwei Guo
- Department of Mechanical Engineering, University College London, London, UK
| | - Yiannis Ventikos
- Department of Mechanical Engineering, University College London, London, UK
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D'Arco F, Ganau M. Which neuroimaging techniques are really needed in Chiari I? A short guide for radiologists and clinicians. Childs Nerv Syst 2019; 35:1801-1808. [PMID: 31147745 DOI: 10.1007/s00381-019-04210-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/15/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE To describe the most appropriate techniques and suggested protocols meant to address the various scenarios that clinicians and pediatric neurosurgeons may face in their day-to-day practice connected with Chiari I. METHODS Current literature related to image indications and findings in Chiari I has been reviewed. The authors focused on both standard and advanced techniques for clinical diagnosis and preoperative planning purposes. DISCUSSION AND CONCLUSION The complexity of providing neuroimaging guidelines for children investigated for Chiari I lies in defining the most appropriate neuroradiology tool to approach what is in fact a very heterogeneous condition with different etiopathogenetic mechanisms and associated abnormalities. Other variables that may influence the diagnostic strategy include the age of the patient, the presence of additional pathological conditions, the type of presenting symptoms, and the indication for surgical or conservative management. Although the average age at time of diagnosis is 10 years, the initial diagnosis may be done at any age, and the referral for neuroradiology workup may come from general practitioners/pediatricians, orthopedic surgeons, and endocrinologists following various baseline investigations including plain x-rays of skull and spine and/or CT head and/or MRI brain and spine.
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Affiliation(s)
- Felice D'Arco
- Great Ormond Street Hospital for Children, London, UK. felice.d'
| | - Mario Ganau
- Department of Neurosurgery, Oxford University Hospitals, London, UK
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Isaacs AM, Shimony JS, Morales DM, Castaneyra-Ruiz L, Hartman A, Cook M, Smyser CD, Strahle J, Smyth MD, Yan Y, McAllister JP, McKinstry RC, Limbrick DD. Feasibility of fast brain diffusion MRI to quantify white matter injury in pediatric hydrocephalus. J Neurosurg Pediatr 2019; 24:461-468. [PMID: 31323624 PMCID: PMC6982356 DOI: 10.3171/2019.5.peds18596] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 05/14/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Traditionally, diffusion MRI (dMRI) has been performed in parallel with high-resolution conventional MRI, which requires long scan times and may require sedation or general anesthesia in infants and young children. Conversely, fast brain MRI permits image acquisition without the need for sedation, although its short pulse sequences, susceptibility to motion artifact, and contrast resolution have limited its use to assessing ventricular size or major structural variations. Here, the authors demonstrate the feasibility of leveraging a 3-direction fast brain MRI protocol to obtain reliable dMRI measures. METHODS Fast brain MRI with 3-direction dMRI was performed in infants and children before and after hydrocephalus treatment. Regions of interest in the posterior limbs of the internal capsules (PLICs) and the genu of the corpus callosum (gCC) were drawn on diffusion-weighted images, and mean diffusivity (MD) data were extracted. Ventricular size was determined by the frontal occipital horn ratio (FOHR). Differences between and within groups pre- and posttreatment, and FOHR-MD correlations were assessed. RESULTS Of 40 patients who met inclusion criteria (median age 27.5 months), 15 (37.5%), 17 (42.5%), and 8 (20.0%) had posthemorrhagic hydrocephalus (PHH), congenital hydrocephalus (CH), or no intracranial abnormality (controls), respectively. A hydrocephalus group included both PHH and CH patients. Prior to treatment, the FOHR (p < 0.001) and PLIC MD (p = 0.027) were greater in the hydrocephalus group than in the controls. While the mean gCC MD in the hydrocephalus group (1.10 × 10-3 mm2/sec) was higher than that of the control group (0.98), the difference was not significant (p = 0.135). Following a median follow-up duration of 14 months, decreases in FOHR, PLIC MD, and gCC MD were observed in the hydrocephalus group and were similar to those in the control group (p = 0.107, p = 0.702, and p = 0.169, respectively). There were no correlations identified between FOHR and MDs at either time point. CONCLUSIONS The utility of fast brain MRI can be extended beyond anatomical assessments to obtain dMRI measures. A reduction in PLIC and gCC MD to levels similar to those of controls was observed within 14 months following shunt surgery for hydrocephalus in PHH and CH infants. Further studies are required to assess the role of fast brain dMRI for assessing clinical outcomes in pediatric hydrocephalus patients.
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Affiliation(s)
- Albert M. Isaacs
- Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Joshua S. Shimony
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Diego M. Morales
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Alexis Hartman
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Madison Cook
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Christopher D. Smyser
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Jennifer Strahle
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew D. Smyth
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Yan Yan
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - James P. McAllister
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Robert C. McKinstry
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - David D. Limbrick
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
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9
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Bateman GA, Bateman AR. Differences in the Calculated Transvenous Pressure Drop between Chronic Hydrocephalus and Idiopathic Intracranial Hypertension. AJNR Am J Neuroradiol 2019; 40:68-73. [PMID: 30467220 DOI: 10.3174/ajnr.a5883] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/02/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Chronic hydrocephalus is associated with dilated ventricles despite a normal intracranial pressure. In idiopathic intracranial hypertension, the ventricles are normal despite an elevated intracranial pressure. This apparent paradox has largely remained unexplained. It is suggested that a pressure difference between the superficial and deep venous territories of the brain could account for the variation between the 2 diseases. The purpose of this paper is to investigate the cause of this pressure difference. MATERIALS AND METHODS Using MR phase-contrast imaging, we calculated the hydraulic diameters of the sagittal and straight sinuses in 21 patients with hydrocephalus, 20 patients with idiopathic intracranial hypertension, and 20 age-matched controls. The outflow resistance of each sinus was estimated using the Poiseuille equation. The outflow pressure was estimated using the flow data. A smaller subset of the patients with hydrocephalus had these studies repeated after successful shunt insertion. RESULTS In hydrocephalus, the sagittal sinuses were 21% smaller than those in controls (P < .001); the straight sinuses were not significantly different. In idiopathic intracranial hypertension, both sinuses were not significantly different from those of controls. The pressure drop from the sagittal sinus to the end of the straight sinus was elevated by 1.2 mm Hg in hydrocephalus (P = .001) but not significantly different from that in controls in idiopathic intracranial hypertension. Shunt insertion dilated the sagittal sinuses in hydrocephalus, leaving them 18% larger than normal and eliminating the transvenous pressure change. CONCLUSIONS There is a transvenous pressure difference in hydrocephalus that is absent in idiopathic intracranial hypertension. This difference is eliminated by shunt insertion. The findings may have a bearing on ventricular dilation.
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Affiliation(s)
- G A Bateman
- From the Department of Medical Imaging (G.A.B.), John Hunter Hospital, Newcastle, New South Wales, Australia
- Newcastle University Faculty of Health (G.A.B.), Callaghan Campus Newcastle, New South Wales, Australia
| | - A R Bateman
- Biomedical Engineering (A.R.B.), University of New South Wales, Sydney, New South Wales, Australia
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Szczepek E, Koszewski W. Letter to the Editor. Development of periventricular lucency with low CSF pressure. J Neurosurg 2018; 128:1266-1268. [DOI: 10.3171/2017.9.jns171221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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11
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Guo L, Vardakis JC, Lassila T, Mitolo M, Ravikumar N, Chou D, Lange M, Sarrami-Foroushani A, Tully BJ, Taylor ZA, Varma S, Venneri A, Frangi AF, Ventikos Y. Subject-specific multi-poroelastic model for exploring the risk factors associated with the early stages of Alzheimer's disease. Interface Focus 2017; 8:20170019. [PMID: 29285346 PMCID: PMC5740222 DOI: 10.1098/rsfs.2017.0019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
There is emerging evidence suggesting that Alzheimer's disease is a vascular disorder, caused by impaired cerebral perfusion, which may be promoted by cardiovascular risk factors that are strongly influenced by lifestyle. In order to develop an understanding of the exact nature of such a hypothesis, a biomechanical understanding of the influence of lifestyle factors is pursued. An extended poroelastic model of perfused parenchymal tissue coupled with separate workflows concerning subject-specific meshes, permeability tensor maps and cerebral blood flow variability is used. The subject-specific datasets used in the modelling of this paper were collected as part of prospective data collection. Two cases were simulated involving male, non-smokers (control and mild cognitive impairment (MCI) case) during two states of activity (high and low). Results showed a marginally reduced clearance of cerebrospinal fluid (CSF)/interstitial fluid (ISF), elevated parenchymal tissue displacement and CSF/ISF accumulation and drainage in the MCI case. The peak perfusion remained at 8 mm s−1 between the two cases.
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Affiliation(s)
- Liwei Guo
- Department of Mechanical Engineering, University College London, London, UK
| | - John C Vardakis
- Department of Mechanical Engineering, University College London, London, UK
| | - Toni Lassila
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, UK
| | | | - Nishant Ravikumar
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), Department of Mechanical Engineering, University of Sheffield, Sheffield, UK
| | - Dean Chou
- Institute of Biomedical Engineering and Department of Engineering Science, University of Oxford, Oxford, UK
| | - Matthias Lange
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, UK
| | - Ali Sarrami-Foroushani
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, UK
| | - Brett J Tully
- Children's Medical Research Institute and School of Medical Sciences, Sydney Medical School, The University of Sydney, Westmead, Australia
| | - Zeike A Taylor
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), Department of Mechanical Engineering, University of Sheffield, Sheffield, UK
| | - Susheel Varma
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, UK
| | - Annalena Venneri
- Department of Neuroscience, Medical School, University of Sheffield, Sheffield, UK
| | - Alejandro F Frangi
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, UK
| | - Yiannis Ventikos
- Department of Mechanical Engineering, University College London, London, UK
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Casaca-Carreira J, Temel Y, Hescham SA, Jahanshahi A. Transependymal Cerebrospinal Fluid Flow: Opportunity for Drug Delivery? Mol Neurobiol 2017; 55:2780-2788. [PMID: 28455692 PMCID: PMC5842497 DOI: 10.1007/s12035-017-0501-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 03/07/2017] [Indexed: 12/23/2022]
Abstract
Drug delivery to the central nervous system (CNS) is complicated by the blood-brain barrier. As a result, many agents that are found to be potentially effective at their site of action cannot be sufficiently or effectively delivered to the CNS and therefore have been discarded and not developed further for clinical use, leaving many CNS diseases untreated. One way to overcome this obstacle is intracerebroventricular (ICV) delivery of the therapeutics directly to cerebrospinal fluid (CSF). Recent experimental and clinical findings reveal that CSF flows from the ventricles throughout the parenchyma towards the subarachnoid space also named minor CSF pathway, while earlier, it was suggested that only in pathological conditions such as hydrocephalus this form of CSF flow occurs. This transependymal flow of CSF provides a route to distribute ICV-infused drugs throughout the brain. More insight on transependymal CSF flow will direct more rational to ICV drug delivery and broaden its clinical indications in managing CNS diseases.
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Affiliation(s)
- João Casaca-Carreira
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- European Graduate School of Neuroscience (EURON), Maastricht, the Netherlands
| | - Yasin Temel
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands
- European Graduate School of Neuroscience (EURON), Maastricht, the Netherlands
| | - Sarah-Anna Hescham
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands
- European Graduate School of Neuroscience (EURON), Maastricht, the Netherlands
| | - Ali Jahanshahi
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands.
- European Graduate School of Neuroscience (EURON), Maastricht, the Netherlands.
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Goffin C, Leonhardt S, Radermacher K. The Role of a Dynamic Craniospinal Compliance in NPH—A Review and Future Challenges. IEEE Rev Biomed Eng 2017; 10:310-322. [DOI: 10.1109/rbme.2016.2620493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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14
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Haubrich C, Czosnyka M, Diehl R, Smielewski P, Czosnyka Z. Ventricular Volume Load Reveals the Mechanoelastic Impact of Communicating Hydrocephalus on Dynamic Cerebral Autoregulation. PLoS One 2016; 11:e0158506. [PMID: 27415784 PMCID: PMC4944997 DOI: 10.1371/journal.pone.0158506] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 06/16/2016] [Indexed: 11/18/2022] Open
Abstract
Several studies have shown that the progression of communicating hydrocephalus is associated with diminished cerebral perfusion and microangiopathy. If communicating hydrocephalus similarly alters the cerebrospinal fluid circulation and cerebral blood flow, both may be related to intracranial mechanoelastic properties as, for instance, the volume pressure compliance. Twenty-three shunted patients with communicating hydrocephalus underwent intraventricular constant-flow infusion with Hartmann's solution. The monitoring included transcranial Doppler (TCD) flow velocities (FV) in the middle (MCA) and posterior cerebral arteries (PCA), intracranial pressure (ICP), and systemic arterial blood pressure (ABP). The analysis covered cerebral perfusion pressure (CPP), the index of pressure-volume compensatory reserve (RAP), and phase shift angles between Mayer waves (3 to 9 cpm) in ABP and MCA-FV or PCA-FV. Due to intraventricular infusion, the pressure-volume reserve was exhausted (RAP) 0.84+/-0.1 and ICP was increased from baseline 11.5+/-5.6 to plateau levels of 20.7+/-6.4 mmHg. The ratio dRAP/dICP distinguished patients with large 0.1+/-0.01, medium 0.05+/-0.02, and small 0.02+/-0.01 intracranial volume compliances. Both M wave phase shift angles (r = 0.64; p<0.01) and CPP (r = 0.36; p<0.05) displayed a gradual decline with decreasing dRAP/dICP gradients. This study showed that in communicating hydrocephalus, CPP and dynamic cerebral autoregulation in particular, depend on the volume-pressure compliance. The results suggested that the alteration of mechanoelastic characteristics contributes to a reduced cerebral perfusion and a loss of autonomy of cerebral blood flow regulation. Results warrant a prospective TCD follow-up to verify whether the alteration of dynamic cerebral autoregulation may indicate a progression of communicating hydrocephalus.
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Affiliation(s)
- Christina Haubrich
- Department of Academic Neurosurgery, Addenbrooke’s Hospital, Cambridge, United Kingdom
- Department of Neurology, University Hospital Aachen, Aachen, Germany
- * E-mail:
| | - Marek Czosnyka
- Department of Academic Neurosurgery, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Rolf Diehl
- Department of Neurology, Alfried-Krupp-Krankenhaus, Essen, Germany
| | - Peter Smielewski
- Department of Academic Neurosurgery, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Zofia Czosnyka
- Department of Academic Neurosurgery, Addenbrooke’s Hospital, Cambridge, United Kingdom
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