Hyperemic hydrocephalus: a new form of childhood hydrocephalus analogous to hyperemic intracranial hypertension in adults

Clinical article

Grant Bateman M.B.B.S., F.R.A.N.Z.C.R.
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  • Department of Medical Imaging, John Hunter Hospital, and University Faculty of Health, Newcastle, New South Wales, Australia
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Object

In the majority of adults with idiopathic intracranial hypertension (IIH), there is an elevation in venous pressure associated with a venous outflow stenosis. In about 15% of IIH patients the elevated venous pressure is associated with an elevation in blood flow but little or no evidence of a stenosis. Venostenotic IIH and idiopathic hydrocephalus in children with a normal blood inflow have been shown to be equivalent. The aim of this study was to test whether children with hydrocephalus and an elevated arterial inflow have a vascular pathophysiology that is analogous to the hyperemic form of IIH in adults.

Methods

Nine children with idiopathic hydrocephalus underwent MR imaging with flow quantification and were found to have arterial inflows 2 SDs above the mean for normal controls. Measurements of the head circumference, ventricular enlargement, total blood inflow, superior sagittal sinus (SSS)/straight sinus (SS) outflow, and the degree of collateral venous flow were performed. The results were compared with findings in 14 age-matched controls.

Results

In hyperemic hydrocephalus the cerebral blood inflow was elevated but the SSS and SS outflows were in the normal range. The sinus outflow as a percentage of the inflow was reduced by 8 percentage points in the SSS territory and 5 percentage points in the SS territory compared with findings in the controls (p = 0.04, p = 0.003, respectively), suggesting blood was returning via collateral channels.

Conclusions

Similar to patients with hyperemic IIH, children with hyperemic hydrocephalus show a significant elevation in collateral venous flow, indicating that the same venous pathophysiology may be operating in both conditions.

Abbreviations used in this paper: AVM = arteriovenous malformation; IIH = idiopathic intracranial hypertension; SS = straight sinus; SSS = superior sagittal sinus.

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Contributor Notes

Address correspondence to: Grant Bateman, M.B.B.S., F.R.A.N.Z.C.R., Department of Medical Imaging, John Hunter Hospital, Locked Bag 1, Newcastle Region Mail Center, 2310 Australia. email: grant.bateman@hnehealth.nsw.gov.au.
  • 1

    Aggarwal S, , Obrist W, , Younas H, , Kramer D, , Kang Y, & Scott V, : Cerebral hemodynamic and metabolic profiles in fulminant hepatic failure: relationship to outcome. Liver Transpl 11:13531360, 2005

    • Search Google Scholar
    • Export Citation
  • 2

    Ayanzen RH, , Bird CR, , Keller FJ, , McCully FJ, , Theobald MR, & Heiserman JE: Cerebral MR venography: normal anatomy and potential diagnostic pitfalls. AJNR Am J Neuroradiol 21:7478, 2000

    • Search Google Scholar
    • Export Citation
  • 3

    Bateman GA: Arterial inflow and venous outflow in idiopathic intracranial hypertension associated with venous outflow stenoses. J Clin Neurosci 15:402408, 2008

    • Search Google Scholar
    • Export Citation
  • 4

    Bateman GA: Association between arterial inflow and venous outflow in idiopathic and secondary intracranial hypertension. J Clin Neurosci 13:550556, 2006

    • Search Google Scholar
    • Export Citation
  • 5

    Bateman GA: Pulse-wave encephalopathy: a comparative study of the hydrodynamics of leukoaraiosis and normal-pressure hydrocephalus. Neuroradiology 44:740748, 2002

    • Search Google Scholar
    • Export Citation
  • 6

    Bateman GA: Vascular hydraulics associated with idiopathic and secondary intracranial hypertension. AJNR Am J Neuroradiol 23:11801186, 2002

    • Search Google Scholar
    • Export Citation
  • 7

    Bateman GA, , Smith RL, & Siddique SH: Idiopathic hydrocephalus in children and idiopathic intracranial hypertension in adults: two manifestations of the same pathophysiological process?. J Neurosurg 107:6 Suppl 439444, 2007

    • Search Google Scholar
    • Export Citation
  • 8

    Bateman GA, , Stevens SA, & Stimpson J: A mathematical model of idiopathic intracranial hypertension incorporating increased arterial inflow and variable venous outflow collapsibility. J Neurosurg 110:446456, 2009

    • Search Google Scholar
    • Export Citation
  • 9

    Cronqvist S, , Granholm L, & Lundstrom NR: Hydrocephalus and congestive heart failure caused by intracranial arteriovenous malformations in infants. J Neurosurg 36:249254, 1972

    • Search Google Scholar
    • Export Citation
  • 10

    Davson H, , Welch K, & Segal MB: Physiology and Pathophysiology of the Cerebrospinal Fluid New York, Churchill Livingstone, 1987. 485521

  • 11

    De Lange SA, & De Vlieger M: Hydrocephalus associated with raised venous pressure. Dev Med Child Neurol 12:22 Suppl 2832, 1970

  • 12

    Enzmann DR, & Pelc NJ: Cerebrospinal fluid flow measured by phase-contrast cine MR. AJNR Am J Neuroradiol 14:13011310, 1992

  • 13

    Evans AJ, , Iwai F, , Grist TA, , Sostman HD, , Hedlund LW, & Spritzer CE, : Magnetic resonance imaging of blood flow with a phase subtraction technique. In vitro and in vivo validation. Invest Radiol 28:109115, 1993

    • Search Google Scholar
    • Export Citation
  • 14

    Gross CE, , Tranmer BI, , Adey G, & Kohut J: Increased cerebral blood flow in idiopathic pseudotumor cerebri. Neurol Res 12:226230, 1990

  • 15

    Hirabuki N, , Watanabe Y, , Mano T, , Fujita N, , Tanaka H, & Ueguchi T, : Quantification of flow in the superior sagittal sinus performed with cine phase-contrast MR imaging of healthy and achondroplastic children. AJNR Am J Neuroradiol 21:14971501, 2000

    • Search Google Scholar
    • Export Citation
  • 16

    Karahalios DG, , Rekate HL, , Khayata MH, & Apostolides PJ: Elevated intracranial venous pressure as a universal mechanism in pseudotumor cerebri of varying etiologies. Neurology 46:198202, 1996

    • Search Google Scholar
    • Export Citation
  • 17

    Laffon E, , Valli N, , Latrabe V, , Franconi JM, , Barat JL, & Laurent F: A validation of a flow quantification by MR phase mapping software. Eur J Radiol 27:166172, 1998

    • Search Google Scholar
    • Export Citation
  • 18

    Ostergaard L, , Johannsen P, , Høst-Poulsen P, , Vestergaard-Poulsen P, , Asboe H, & Gee AD, : Cerebral blood flow measurements by magnetic resonance imaging bolus tracking: comparison with [15O]H2O positron emission tomography in humans. J Cereb Flow Metab 18:935940, 1998

    • Search Google Scholar
    • Export Citation
  • 19

    Powell AJ, , Maier SE, , Chung T, & Geva T: Phase-velocity cine magnetic resonance imaging measurement of pulsatile blood flow in children and young adults: in vitro and in vivo validation. Pediatr Cardiol 21:104110, 2000

    • Search Google Scholar
    • Export Citation
  • 20

    Rollins N, , Claro I, , Booth T, & Chia J: MR venography in the pediatric patient. AJNR Am J Neuroradiol 26:5055, 2005

  • 21

    Rosman NP, & Shands KN: Hydrocephalus caused by increased intracranial venous pressure: a clinicopathological study. Ann Neurol 3:445450, 1978

    • Search Google Scholar
    • Export Citation
  • 22

    Sainte-Rose C, , LaCombe J, , Pierre-Kahn A, , Renier D, & Hirsch JF: Intracranial venous sinus hypertension: cause or consequence of hydrocephalus in infants?. J Neurosurg 60:727736, 1984

    • Search Google Scholar
    • Export Citation
  • 23

    Shawcross DL, , Davies NA, , Mookerjee RP, , Hayes PC, , Williams R, & Lee A, : Worsening of cerebral hyperemia by the administration of Terlipressin in acute liver failure with severe encephalopathy. Hepatology 39:471475, 2004

    • Search Google Scholar
    • Export Citation
  • 24

    Shulman K, & Ransohoff J: Sagittal sinus pressure in hydrocephalus. J Neurosurg 23:169173, 1965

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