An Objective Study of Anatomic Shifts in Intracranial Hypotension Using Four Anatomic Planes
Purpose. Intracranial hypotension (IH) often remains undetected using current MR diagnostic criteria. This project aims to demonstrate that central incisural herniation is highly effective in helping to make this diagnosis. Materials and Methods. Magnetic resonance imaging (MRI) was analyzed in 200...
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| Format: | Article |
| Language: | English |
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Wiley
2018-01-01
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| Series: | Radiology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2018/6862739 |
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| author | Shamar J. Young Ronald G. Quisling Sharatchandra Bidari Tina S. Sanghvi |
| author_facet | Shamar J. Young Ronald G. Quisling Sharatchandra Bidari Tina S. Sanghvi |
| author_sort | Shamar J. Young |
| collection | DOAJ |
| description | Purpose. Intracranial hypotension (IH) often remains undetected using current MR diagnostic criteria. This project aims to demonstrate that central incisural herniation is highly effective in helping to make this diagnosis. Materials and Methods. Magnetic resonance imaging (MRI) was analyzed in 200 normal and 81 clinically known IH patients. MRI reference lines approximating the plane of the incisura, the plane of the diaphragma sella, the plane of the foramen magnum, and the plane of the visual pathway were utilized to measure the position of selected brain structures relative to these reference lines. Results. All IH patients had highly statistically significant (p<0.0001) measurable evidence of downward central incisural herniation when compared to normal controls. The first of the important observations was a downward shift of the mammillary bodies, which shortened the midsagittal width of the interpeduncular fossa cistern. A concurrent downward shift and deformity of the tuber cinereum accompanied the mammillary body shift. The second essential observation was an abnormal clockwise rotation of the long axis of the visual pathway. A severity grading system is proposed based on the extent of these shifts as well as secondary shifts of the brain stem, splenium, and cerebellar tonsils. Conclusion. This study objectively delineates the anatomic shifts of brain structures adjacent to the incisura and foramen magnum. This methodology is sufficient to recognize the features of IH and to stratify the spectrum of IH findings into a functional grading system for quantifying the results of interventional therapy. |
| format | Article |
| id | doaj-art-967a83025d234ddfbec7da3baba1d8ee |
| institution | Kabale University |
| issn | 2090-1941 2090-195X |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
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| series | Radiology Research and Practice |
| spelling | doaj-art-967a83025d234ddfbec7da3baba1d8ee2025-02-03T06:11:21ZengWileyRadiology Research and Practice2090-19412090-195X2018-01-01201810.1155/2018/68627396862739An Objective Study of Anatomic Shifts in Intracranial Hypotension Using Four Anatomic PlanesShamar J. Young0Ronald G. Quisling1Sharatchandra Bidari2Tina S. Sanghvi3Department of Radiology, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, USADepartment of Diagnostic Radiology, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610, USADepartment of Diagnostic Radiology, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610, USADepartment of Radiology, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, USAPurpose. Intracranial hypotension (IH) often remains undetected using current MR diagnostic criteria. This project aims to demonstrate that central incisural herniation is highly effective in helping to make this diagnosis. Materials and Methods. Magnetic resonance imaging (MRI) was analyzed in 200 normal and 81 clinically known IH patients. MRI reference lines approximating the plane of the incisura, the plane of the diaphragma sella, the plane of the foramen magnum, and the plane of the visual pathway were utilized to measure the position of selected brain structures relative to these reference lines. Results. All IH patients had highly statistically significant (p<0.0001) measurable evidence of downward central incisural herniation when compared to normal controls. The first of the important observations was a downward shift of the mammillary bodies, which shortened the midsagittal width of the interpeduncular fossa cistern. A concurrent downward shift and deformity of the tuber cinereum accompanied the mammillary body shift. The second essential observation was an abnormal clockwise rotation of the long axis of the visual pathway. A severity grading system is proposed based on the extent of these shifts as well as secondary shifts of the brain stem, splenium, and cerebellar tonsils. Conclusion. This study objectively delineates the anatomic shifts of brain structures adjacent to the incisura and foramen magnum. This methodology is sufficient to recognize the features of IH and to stratify the spectrum of IH findings into a functional grading system for quantifying the results of interventional therapy.http://dx.doi.org/10.1155/2018/6862739 |
| spellingShingle | Shamar J. Young Ronald G. Quisling Sharatchandra Bidari Tina S. Sanghvi An Objective Study of Anatomic Shifts in Intracranial Hypotension Using Four Anatomic Planes Radiology Research and Practice |
| title | An Objective Study of Anatomic Shifts in Intracranial Hypotension Using Four Anatomic Planes |
| title_full | An Objective Study of Anatomic Shifts in Intracranial Hypotension Using Four Anatomic Planes |
| title_fullStr | An Objective Study of Anatomic Shifts in Intracranial Hypotension Using Four Anatomic Planes |
| title_full_unstemmed | An Objective Study of Anatomic Shifts in Intracranial Hypotension Using Four Anatomic Planes |
| title_short | An Objective Study of Anatomic Shifts in Intracranial Hypotension Using Four Anatomic Planes |
| title_sort | objective study of anatomic shifts in intracranial hypotension using four anatomic planes |
| url | http://dx.doi.org/10.1155/2018/6862739 |
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