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Ventricle wall movements and cerebrospinal fluid flow in hydrocephalus.
[hydrocephalus with stenosis of the aqueduct of sylvius]
The
dynamics
of
fluid
flow
in
normal
pressure
hydrocephalus
(
NPH
)
are
poorly
understood
.
Normally
,
CSF
flows
out
of
the
brain
through
the
ventricles
.
However
,
ventricular
enlargement
during
NPH
may
be
caused
by
CSF
backflow
into
the
brain
through
the
ventricles
.
A
previous
study
showed
this
reversal
of
flow
;
in
the
present
study
,
the
authors
provide
additional
clinical
data
obtained
in
patients
with
NPH
and
supplement
these
data
with
computer
simulations
to
better
understand
the
CSF
flow
and
ventricular
wall
displacement
and
emphasize
its
clinical
implications
.
Three
NPH
patients
and
1
patient
with
aqueductal
stenosis
underwent
cine
phase-contrast
MR
imaging
(
cine
MR
imaging
)
for
measurement
of
CSF
flow
and
ventricle
wall
movement
during
the
cardiac
cycle
.
These
data
were
compared
to
data
previously
obtained
in
8
healthy
volunteers
.
The
CSF
flow
measurements
were
obtained
at
the
outlet
of
the
aqueduct
of
Sylvius
.
Calculation
of
the
ventricular
wall
movement
was
determined
from
the
complete
set
of
cine
MR
images
obtained
axially
at
the
middle
of
the
lateral
ventricle
.
The
data
were
obtained
before
and
after
CSF
removal
with
a
ventriculoperitoneal
shunt
with
an
adjustable
valve
.
To
supplement
the
clinical
data
,
a
computational
model
was
used
to
predict
the
transmural
pressure
and
flow
.
In
healthy
volunteers
,
net
CSF
aqueductal
flow
was
1
.
2
ml
/
minute
in
the
craniocaudal
direction
.
In
patients
with
NPH
,
the
net
CSF
flow
was
in
the
opposite
direction--the
caudocranial
direction--before
shunt
placement
.
After
shunting
,
the
magnitude
of
the
abnormal
fluid
flow
decreased
or
reversed
,
with
the
flow
resembling
the
normal
flow
patterns
observed
in
healthy
volunteers
.
The
authors
'
MR
imaging-based
measurements
of
the
CSF
flow
direction
and
lateral
ventricle
volume
size
change
and
the
results
of
computer
modeling
of
fluid
dynamics
lead
them
to
conclude
that
the
directional
pattern
and
magnitude
of
CSF
flow
in
patients
with
NPH
may
be
an
indication
of
the
disease
state
.
This
has
practical
implications
for
shunt
design
and
understanding
the
mechanisms
that
produce
hydrocephalus
.
Diseases
Validation
Diseases presenting
"brain through the ventricles"
symptom
hydrocephalus with stenosis of the aqueduct of sylvius
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