AstudyofCSFdynamicsinnormalpressurehydrocephalusphase.docVIP

The role of phase contrast MRI scanning in selecting normal pressure hydrocephalus patients for V-P shunting. By MUHAMMAD IMRAN BHATTI (FRCS Ed Neurosurgery) Abstract Normal pressure hydrocephalus (NPH) is a known cause of dementia. It is the only type of dementia that can be treated surgically by putting a ventriculo-peritoneal shunt to drain excess cerebrospinal fluid (CSF) from the ventricles of the brain. In addition, it is associated with difficulty in walking (which usually precedes dementia) and incontinence (which usually follows dementia). It is important to diagnose this condition properly as there are other dementia types and different neurological conditions which present in a similar way but would not respond to any surgical intervention. A number of different invasive and non-invasive tests are required to differentiate these various conditions from each other and to select the appropriate patients who would respond to shunting. Computerized tomography and simple magnetic resonance imaging (MRI) of the head are widely used clinically as part of the investigations, but these are not completely reliable. Cine Phase contrast MRI scanning is a more sophisticated technique of examining the flow of CSF through different regions of the brain. This study prospectively investigated the role of cine phase contrast MRI scanning in calculating the various CSF flow variables through the cerebral aqueduct and studied their relationship with the patient selection for shunting. The decision for shunting was based on the usual clinical grounds and the treating physician was blinded by the results of the CSF flow characteristics. For analysis of the results patients were divided into two groups depending on whether they had only one or two MRI scans (the second scan was performed after drainage of two hundred ml of CSF via the lumbar drain). There were seventeen patients in the first group (10 males and 7 females). There wa