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Fluids and Barriers of the CNS
Published in: Fluids and Barriers of the CNS 1/2020

01-12-2020 | Central Nervous System Trauma | Research

Cerebrospinal fluid dynamics in non-acute post-traumatic ventriculomegaly

Authors: Afroditi D. Lalou, Virginia Levrini, Marek Czosnyka, Laurent Gergelé, Matthew Garnett, Angelos Kolias, Peter J. Hutchinson, Zofia Czosnyka

Published in: Fluids and Barriers of the CNS | Issue 1/2020

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Abstract

Background

Post-traumatic hydrocephalus (PTH) is potentially under-diagnosed and under-treated, generating the need for a more efficient diagnostic tool. We aim to report CSF dynamics of patients with post-traumatic ventriculomegaly.

Materials and methods

We retrospectively analysed post-traumatic brain injury (TBI) patients with ventriculomegaly who had undergone a CSF infusion test. We calculated the resistance to CSF outflow (Rout), AMP (pulse amplitude of intracranial pressure, ICP), dAMP (AMPplateau-AMPbaseline) and compensatory reserve index correlation coefficient between ICP and AMP (RAP). To avoid confounding factors, included patients had to be non-decompressed or with cranioplasty > 1 month previously and Rout > 6 mmHg/min/ml. Compliance was assessed using the elasticity coefficient. We also compared infusion-tested TBI patients selected for shunting versus those not selected for shunting (consultant decision based on clinical and radiological assessment and the infusion results). Finally, we used data from a group of shunted idiopathic Normal Pressure Hydrocephalus (iNPH) patients for comparison.

Results

Group A consisted of 36 patients with post-traumatic ventriculomegaly and Group B of 45 iNPH shunt responders. AMP and dAMP were significantly lower in Group A than B (0.55 ± 0.39 vs 1.02 ± 0.72; p < 0.01 and 1.58 ± 1.21 vs 2.76 ± 1.5; p < 0.01. RAP baseline was not significantly different between the two. Elasticity was higher than the normal limit in all groups (average 0.18 1/ml). Significantly higher Rout was present in those with probable PTH selected for shunting compared with unshunted. Mild/moderate hydrocephalus, ex-vacuo ventriculomegaly/encephalomalacia were inconsistently reported in PTH patients.

Conclusions

Rout and AMP were significantly lower in PTH compared to iNPH and did not always reflect the degree of hydrocephalus or atrophy reported on CT/MRI. Compliance appears reduced in PTH.
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Metadata
Title
Cerebrospinal fluid dynamics in non-acute post-traumatic ventriculomegaly
Authors
Afroditi D. Lalou
Virginia Levrini
Marek Czosnyka
Laurent Gergelé
Matthew Garnett
Angelos Kolias
Peter J. Hutchinson
Zofia Czosnyka
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Fluids and Barriers of the CNS / Issue 1/2020
Electronic ISSN: 2045-8118
DOI
https://doi.org/10.1186/s12987-020-00184-6

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