Department of Medical and Surgical Sciences Neuroscience Centre Magna Græcia University of Catanzaro Catanzaro Italy.
Department of Medical and Surgical Sciences Center for Headache and Intracranial Pressure Disorders Institute of Neurology Magna Græcia University of Catanzaro Catanzaro Italy.
Ann Clin Transl Neurol. 2019 Jan 18;6(2):233-242. doi: 10.1002/acn3.685. eCollection 2019 Feb.
To evaluate whether increased cerebrospinal fluid (CSF) pressure causes alteration of periventricular white matter (WM) microstructure in patients with idiopathic intracranial hypertension (IIH).
In a prospective study, patients with refractory chronic headache with and without IIH performed a neuroimaging study including 3T MRI, 3D Phase Contrast MR venography, and diffusion tensor imaging (DTI) of the brain. Whole-brain voxel-wise comparisons of DTI abnormalities of WM were performed using tract-based spatial statistics. A correlation analysis between DTI indices and CSF opening pressure, highest peak, and mean pressure was also performed in patients with IIH.
We enrolled 62 consecutive patients with refractory chronic headaches. Thirty-five patients with IIH, and 27 patients without increased intracranial pressure. DTI analysis revealed no fractional anisotropy changes, but decreased mean, axial, and radial diffusivity in body (IIH = 0.80 ± 0.04, non-IIH = 0.84 ± 0.4, IIH = 1.67 ± 0.07, non-IIH = 1.74 ± 0.05, IIH = 0.38 ± 0.04, non-IIH = 0.42 ± 0.05 [mm/sec × 10]) of corpus callosum, and in right superior corona radiata (IIH = 0.75 ± 0.04, non-IIH = 0.79 ± 0.05, IIH = 1.19 ± 0.07, non-IIH = 1.28 ± 0.09, IIH = 0.59 ± 0.03, non-IIH = 0.53 ± 0.03 [mm/sec × 10]) of 35 patients with IIH compared with 27 patients without increased intracranial pressure. DTI indices were negatively correlated with high CSF pressures (<0.05). After medical treatment, eight patients showed incremented MD in anterior corona radiata left and right and superior corona radiata right.
There is significant DTI alteration in periventricular WM microstructure of patients with IIH suggesting tissue compaction correlated with high CSF pressure. This periventricular WM change may be partially reversible after medical treatment.
评估颅内压增高是否会导致特发性颅内高压（IIH）患者的脑室周围白质（WM）微观结构发生改变。
在一项前瞻性研究中，患有难治性慢性头痛的患者进行了神经影像学研究，包括 3T MRI、3D 相位对比 MR 静脉造影和大脑弥散张量成像（DTI）。使用基于束的空间统计学对 WM 的 DTI 异常进行全脑体素比较。还对 IIH 患者的 DTI 指数与 CSF 开口压力、最高峰值和平均压力之间进行了相关性分析。
我们共纳入了 62 例难治性慢性头痛患者。35 例 IIH 患者，27 例无颅内压增高。DTI 分析显示没有各向异性分数的变化，但胼胝体体部的平均、轴向和径向弥散度降低（IIH=0.80±0.04，非-IIH=0.84±0.4，IIH=1.67±0.07，非-IIH=1.74±0.05，IIH=0.38±0.04，非-IIH=0.42±0.05[mm/sec×10]），右侧上放射冠也如此（IIH=0.75±0.04，非-IIH=0.79±0.05，IIH=1.19±0.07，非-IIH=1.28±0.09，IIH=0.59±0.03，非-IIH=0.53±0.03[mm/sec×10]）。与 27 例无颅内压增高的患者相比，35 例 IIH 患者的这些部位存在 DTI 指数降低的现象。DTI 指数与高 CSF 压力呈负相关（<0.05）。经过药物治疗，8 例患者的左右侧前放射冠和右侧上放射冠的 MD 值增加。
IIH 患者的脑室周围 WM 微观结构存在明显的 DTI 改变，提示组织压实与高 CSF 压力有关。这种脑室周围 WM 的变化在药物治疗后可能部分是可逆的。
