R Pradeep, Gupta Dhananjay, Shetty Nikith, Bhushan Anjani Kumar, Haskar Krishna, Gogineni Sujana, Mehta Anish, Javali Mahendra, Acharya Purshottam T, Srinivasa Rangasetty
Department of Neurology, Ramaiah Medical College, Bengaluru, Karnataka, India.
Department of Neurology, Kasturba Medical College, Manipal, Karnataka, India.
J Neurosci Rural Pract. 2020 Apr;11(2):309-314. doi: 10.1055/s-0040-1710086. Epub 2020 May 2.
Idiopathic intracranial hypertension (IIH) is a disorder of unknown origin, characterized by features of raised intracranial pressure (ICP). Existing literature is inconclusive about the role of transcranial Doppler (TCD) in the management of IIH. To study the TCD changes in IIH patients, pre- and post-cerebrospinal fluid (CSF) drainage. This was a prospective study, conducted between July 2017 and December 2019, in a tertiary care referral center in South India. Sixteen consecutive patients, suspected to have IIH, underwent magnetic resonance imaging ofthe brain, a baseline TCD, and lumbar puncture with CSF drainage and pressure monitoring. Post-CSF drainage, TCD was repeated and mean flow velocities, peak systolic velocities, end-diastolic velocities, and pulsatility index (PI), in the middle cerebral artery (MCA), vertebral artery, and basilar artery (BA) were noted. Thirteen patients had elevated CSF pressure, and fulfilled the diagnostic criteria for IIH. These patients were included in the final analysis and pre- and post-CSF drainage TCD blood flow velocities and PI were compared. The mean age of study participants was 29.92 ± 6.92 years. There was a significant reduction in the cerebral flow velocities in bilateral MCA, after CSF drainage and normalization of ICP. Flow velocities in posterior circulation and PI in MCA, PCA, and BA showed an insignificant reduction. Two patients, who did not show any reduction in flow velocities after CSF drainage, developed optic atrophy on follow-up. TCD-derived systolic blood flow velocities can be used in the management and follow-up of patients with IIH.
特发性颅内高压（IIH）是一种病因不明的疾病，其特征为颅内压（ICP）升高。现有文献对于经颅多普勒（TCD）在IIH治疗中的作用尚无定论。
为研究IIH患者脑脊液（CSF）引流前后的TCD变化。
这是一项前瞻性研究，于2017年7月至2019年12月在印度南部的一家三级医疗转诊中心进行。连续16例疑似患有IIH的患者接受了脑部磁共振成像、基线TCD检查以及腰椎穿刺以进行CSF引流和压力监测。CSF引流后，重复进行TCD检查，并记录大脑中动脉（MCA）、椎动脉和基底动脉（BA）的平均流速、收缩期峰值流速、舒张末期流速和搏动指数（PI）。13例患者CSF压力升高，符合IIH的诊断标准。这些患者被纳入最终分析，并比较CSF引流前后的TCD血流速度和PI。
研究参与者的平均年龄为29.92±6.92岁。CSF引流和ICP正常化后，双侧MCA的脑血流速度显著降低。后循环的流速以及MCA、大脑后动脉（PCA）和BA的PI显示出不显著的降低。两名患者在CSF引流后血流速度未显示任何降低，随访时出现了视神经萎缩。
TCD得出的收缩期血流速度可用于IIH患者的治疗和随访。
