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Magnetic resonance imaging quantification of compliance and collateral flow in late-onset idiopathic aqueductal stenosis: venous pathophysiology revisited.
[hydrocephalus with stenosis of the aqueduct of sylvius]
Findings
in
animal
models
of
noncommunicating
hydrocephalus
have
suggested
that
a
reduction
in
compliance
of
the
superior
sagittal
sinus
,
an
elevation
in
venous
outflow
pressure
,
and
the
development
of
venous
collateral
flow
may
be
associated
with
this
condition
.
Although
elevated
venous
pressure
is
known
to
cause
hydrocephalus
in
children
,
this
mechanism
has
fallen
out
of
favor
as
a
theory
in
adults
.
Twenty
-
one
patients
with
late-onset
idiopathic
aqueductal
stenosis
(
LIAS
)
underwent
magnetic
resonance
imaging
with
flow
quantification
measuring
the
degree
of
ventricular
enlargement
,
sulcal
compression
,
total
blood
inflow
,
superior
sagittal
/
straight
sinus
outflow
,
aqueduct
flow
,
arteriovenous
delay
(
AVD
)
,
and
the
extent
of
collateral
venous
flow
.
Data
obtained
in
these
patients
were
compared
with
those
obtained
in
21
age-matched
control
individuals
.
There
was
a
reduction
in
compliance
in
the
patients
with
LIAS
in
whom
the
AVD
decreased
by
50
%
(
p
=
0
.
01
)
.
The
arterial
inflow
and
the
straight
sinus
outflow
were
normal
,
but
the
sagittal
sinus
outflow
was
reduced
by
23
%
(
p
=
0
.
001
)
.
This
indicated
that
significant
collateral
venous
outflow
pathways
were
draining
blood
away
from
the
superficial
but
not
the
deep
drainage
system
.
Similar
to
the
animal
models
,
patients
with
LIAS
exhibit
a
reduced
venous
compliance
and
an
elevation
in
venous
collateral
flow
.
Together
,
these
findings
suggest
that
an
elevation
in
venous
pressure
may
be
associated
with
this
disease
process
.
A
review
of
the
literature
has
indicated
that
only
subtle
differences
may
exist
in
the
pathophysiology
among
patients
with
LIAS
,
normal-pressure
hydrocephalus
,
and
idiopathic
intracranial
hypertension
.
Diseases
Validation
Diseases presenting
"intracranial hypertension"
symptom
achondroplasia
cushing syndrome
hydrocephalus with stenosis of the aqueduct of sylvius
von hippel-lindau disease
This symptom has already been validated