Reduced Jet Velocity in Venous Flow after CSF Drainage: Assessing Hemodynamic Causes of Pulsatile Tinnitus
Reduced Jet Velocity in Venous Flow after CSF Drainage: Assessing Hemodynamic Causes of Pulsatile Tinnitus
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DOI：
10.3174/ajnr.a6043
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发表时间：
2019-05-01
影响因子：
3.5
通讯作者：
Amans, M. R.
中科院分区：
文献类型：
--
作者：
Haraldsson, H.;Leach, J. R.;Amans, M. R.
背景和目的：特发性颅内高压通常与横窦狭窄有关，横窦狭窄是脉动性耳鸣的静脉原因。在特发性颅内高压患者中，通过腰椎穿刺进行CSF引流可降低颅内压，从而缓解狭窄，并可至少暂时停止搏动性耳鸣。本研究的目的是评估静脉血流量的变化所造成的颅内压降低脉动性耳鸣的患者，以帮助确定原因的脉动性tinnitude.MATERIALS和METHODS：10例疑似横窦狭窄的静脉病因脉动性耳鸣症状进行磁共振成像前后腰椎穿刺在同一届会议。方案包括腰穿前后的血流评估和搏动性耳鸣强度评级以及腰穿前的MR静脉造影。结果：腰椎穿刺后静脉峰值流速降低与开放压相关（r =-0.72，P = 0.019），而不伴随流速降低。使用射流的患者其峰值速度降低了0.30 - 0.18 m/s（P = 0.002），与CSF压力降低（r = 0.82，P = 0.024）和主观评分的脉动性耳鸣强度降低（r = 0.78，P = 0.023）相关。腰椎穿刺后的MR静脉造影表现出缓解的stenosis.CONCLUSIONS：我们的研究结果表明，腰椎穿刺引起的静脉峰值流速的减少，而不伴随着流速的减少。我们推测这种减少是由于腰椎穿刺后狭窄扩大所致。我们的研究结果进一步表明，峰值速度和脉动性耳鸣强度之间的相关性，这表明射流是有助于声音的发展。
BACKGROUND AND PURPOSE: Idiopathic intracranial hypertension is commonly associated with transverse sinus stenosis, a venous cause of pulsatile tinnitus. In patients with idiopathic intracranial hypertension, CSF drainage via lumbar puncture decreases intracranial pressure, which relieves the stenosis, and may provide at least temporary cessation of pulsatile tinnitus. The objective of this study was to evaluate changes in venous blood flow caused by lowered intracranial pressure in patients with pulsatile tinnitus to help identify the cause of pulsatile tinnitus.MATERIALS AND METHODS: Ten patients with suspected transverse sinus stenosis as a venous etiology for pulsatile tinnitus symptoms underwent MR imaging before and after lumbar puncture in the same session. The protocol included flow assessment and rating of pulsatile tinnitus intensity before and after lumbar puncture and MR venography before lumbar puncture. Post-lumbar puncture MR venography was performed in 1 subject.RESULTS: There was a lumbar puncture-induced reduction in venous peak velocity that correlated with the opening pressure (r = -0.72, P = .019) without a concomitant reduction in flow rate. Patients with flow jets had their peak velocity reduced by 0.30 0.18 m/s (P = .002), correlating with a reduction in CSF pressure (r = 0.82, P = .024) and the reduction in subjectively scored pulsatile tinnitus intensity (r = 0.78, P = .023). The post-lumbar puncture MR venography demonstrated alleviation of the stenosis.CONCLUSIONS: Our results show a lumbar puncture-induced reduction in venous peak velocity without a concomitant reduction in flow rate. We hypothesize that the reduction is caused by the expansion of the stenosis after lumbar puncture. Our results further show a correlation between the peak velocity and pulsatile tinnitus intensity, suggesting the flow jet to be instrumental in the development of sound.