A Study of Cerebrospinal Fluid Flow Dynamics in patients with Cerebral Venous Thrombosis

Bharani, K (2013) A Study of Cerebrospinal Fluid Flow Dynamics in patients with Cerebral Venous Thrombosis. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Thrombosis of cerebral veins is a distinct cerebrovascular disorder that most often affects young adults and children. Cerebral venous thrombosis is far more common than previously assumed. The spectrum of its clinical presentation is extremely wide and course is highly variable. There are three intracranial compartments namely the brain tissue, blood and CSF that if any pathology involves these will result in intracranial hypertension. Thrombosis of a cerebral venous sinus results in impediment of the sinus blood outflow. This causes increase in CSF pressure and increase in intracerebral venous blood pressure causing brain edema. With time, probably due to establishment of collateral venous circulation there is resolution of brain edema, cerebral sinus compression and resolution of CSF pressure. An occlusion of superior saggital sinus may to some degree, obstruct resorption of CSF by the arachnoid villi, leading to increased CSF pressure. But studies done so far find only small disturbance in CSF absorption process with only a minor contribution to intracranial pressure elevation. Hence we propose to study the CSF flow dynamics by bolus saline infusion method and analyse its relation to the various sites of venous sinus thrombosis proven radiologically by MRV. AIMS AND OBJECTIVES: 1. To study the cerebrospinal fluid opening pressure and outflow resistance in patients with cerebral venous sinus thrombosis. 2. To analyse the correlation between Intra Cerebral Pressure and the site of venous sinus thrombosis. 3. To analyse the correlation between clinical symptoms and outcome with the site of sinus thrombosis. MATERIALS AND METHODS: The study was done at Institute of Neurology, Government General Hospital and Madras Medical College, Chennai during the period of September 2010 to January 2013. Patients admitted in the hospital with the clinical suspicion of cerebral venous sinus thrombosis were included in the study after confirming the diagnosis by MRI with MRV. Detailed clinical history and examination were recorded. Among this group those patients with general contraindications for lumbar puncture procedure such as bleeding disorders, thrombocytopenia(platelet count < 100,000), unequal supratentorial pressure, skin infection at puncture site etc. were excluded. All those included in the study were subjected to lumbar puncture and CSF flow dynamics study by modified bolus injection method, the MIN method using bedside saline manometer. RESULTS: Our study is a cross sectional study including 30 patients diagnosed as CVST confirmed with MRI/MRV, for whom we have measured the CSF flow dynamics. The mean age of the study group is 31 yrs. Among the total 30 cases, 16 were male and 14 were female. 86.7% did complain of headache and 60% had papilledema. 56.7% of the study group had SSS thrombosis, transverse sinus thrombosis in 56.7%, 30% had sigmoid sinus thrombosis and 10% had straight sinus thrombosis. Of the total 53.3% had persistent headache even after treatment. Among those who complained of persistent headache, 75% had SSS thrombosis (P=0.035). The mean Rout is 41.83 mm Hg/ml/min and higher range of Rout was present in patients with SSS thrombosis (P=0.001). The mean Rout in those with persistent headache was in a higher range (49.81mm Hg/ml/min) with P=0.027. 72.2% with SSS thrombosis had papilledema ( P=0.035). CONCLUSION: 1. The cerebrospinal fluid opening pressure Po and the outflow resistance Rout were in a higher range in patients with cerebral venous sinus thrombosis. 2. The opening pressure Po and outflow resistance Rout were higher in patients with superior sagittal sinus thrombosis when compared to other sites of sinus involvement. 3. The patients with superior sagittal sinus thrombosis had the higher incidence of headache ,papilledema and also did complain of persistent headache even after medical treatment. 4. The increase in Rout suggests that the raised ICP due to reduced compliance will take longer time to normalise inspite of recanalisation secondary to anticoagulant therapy. 5. In view of persistent headache, these patients will require long term medical treatment for raised ICP. 6. For unexplained reasons, these group of patients do not develop hydrocephalus inspite of raised ICP.

Item Type: Thesis (Masters)
Additional Information: Reg.No.16101003
Uncontrolled Keywords: Cerebrospinal Fluid Flow Dynamics, Cerebral Venous Thrombosis.
Subjects: MEDICAL > Neurology
Depositing User: Subramani R
Date Deposited: 27 Mar 2020 09:45
Last Modified: 27 Mar 2020 09:45
URI: http://repository-tnmgrmu.ac.in/id/eprint/12492

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