Department of Medical Imaging, John Hunter Hospital, Newcastle Region Mail Center, Locked Bag 1, Newcastle, NSW, 2310, Australia.
Newcastle University Faculty of Health, Callaghan Campus, Newcastle, NSW, Australia.
Fluids Barriers CNS. 2020 Sep 29;17(1):59. doi: 10.1186/s12987-020-00221-4.
Children referred to a tertiary hospital for the indication, "rule out idiopathic intracranial hypertension (IIH)" may have an increased risk of raised venous sinus pressure. An increase in sinus pressure could be due to obesity, venous outflow stenosis or cerebral hyperemia. The purpose of this paper is to define the incidence of each of these variables in these children.
Following a data base review, 42 children between the ages of 3 and 15 years were found to have been referred over a 10 year period. The body mass index was assessed. The cross sectional areas and circumferences of the venous sinuses were measured at 4 levels to calculate the hydraulic and effective diameters. The arterial inflow, sagittal and straight sinus outflows were measured. Automatic cerebral volumetry allowed the brain volume and cerebral blood flow (CBF) to be calculated. The optic nerve sheath diameter was used as a surrogate marker of raised intracranial pressure (ICP). The sagittal sinus percentage venous return was used as a surrogate marker of elevated venous pressure. Age and sex matched control groups were used for comparison.
Compared to controls, the obesity rates were not significantly different in this cohort. Compared to controls, those at risk for IIH had a 17% reduction in transverse sinus and 14% reduction in sigmoid sinus effective cross sectional area (p = 0.005 and 0.0009). Compared to controls, the patients at risk for IIH had an arterial inflow increased by 34% (p < 0.0001) with a 9% larger brain volume (p = 0.02) giving an increase in CBF of 22% (p = 0.005). The sagittal and straight sinus venous return were reduced by 11% and 4% respectively (p < 0.0001 and 0.0009) suggesting raised venous sinus pressure. Forty five percent of the patients were classified as hyperemic and these had optic nerve sheath diameters 17% larger than controls (p < 0.0002) suggesting raised ICP.
In children with the chronic headache/ IIH spectrum, the highest associations were with cerebral hyperemia and mild venous sinus stenosis. Obesity was not significantly different in this cohort. There is evidence to suggest hyperemia increases the venous sinus pressure and ICP.
因“排除特发性颅内高压（IIH）”而转诊至三级医院的儿童，其静脉窦压升高的风险可能增加。窦压升高可能是由于肥胖、静脉流出狭窄或脑充血所致。本文旨在确定这些儿童中这些变量各自的发生率。
通过数据库回顾，在 10 年间发现 42 名 3 至 15 岁的儿童被转诊。评估体重指数。在 4 个水平测量静脉窦的横截面积和周长，以计算液压和有效直径。测量动脉流入、矢状窦和直窦流出量。自动脑容积测量允许计算脑体积和脑血流量（CBF）。视神经鞘直径用作颅内压升高（ICP）的替代标志物。矢状窦静脉回流量百分比用作静脉压升高的替代标志物。使用年龄和性别匹配的对照组进行比较。
与对照组相比，该队列中肥胖率无显著差异。与对照组相比，IIH 风险患者横窦有效横截面积减少 17%，乙状窦有效横截面积减少 14%（p=0.005 和 0.0009）。与对照组相比，IIH 风险患者动脉流入增加 34%（p<0.0001），脑体积增加 9%（p=0.02），脑血流量增加 22%（p=0.005）。矢状窦和直窦静脉回流分别减少 11%和 4%（p<0.0001 和 0.0009），提示静脉窦压升高。45%的患者被归类为充血性，视神经鞘直径比对照组大 17%（p<0.0002），提示 ICP 升高。
在患有慢性头痛/IIH 谱系的儿童中，与脑充血和轻度静脉窦狭窄的相关性最高。在该队列中，肥胖率无显著差异。有证据表明充血会增加静脉窦压和 ICP。
