Experimental and clinical studies on the intracranial pressure, cerebral hemodynamics and cerebral energy metabolism in the disturbance of CSF dynamics

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The purpose is to determine influence of the disturbance of CSF dynamics on the intracranial pressure, the cerebral hemodynamics, and the cerebral energy metabolism by experimental and clinical studies. In the experimental study internal hydrocephalus was produced by the cisternal injection of the kaolin using rabbits and dogs. In acute and subacute stages, there was no significant change in total water content in the gray matter and periventricular white matter. There was, however, significant increase in free water contents in the white matter in all stages, but not in the gray matter. The intracranial pressure decreased at the second week following cisternal injection of kaolin. MR spectroscopy revealed that the ratio PCr/Pi decreased in acute and subacute stage of the canine hydrocephalus, but there was no change in PCr/Pi ratio of the hydrocephalic dog brain of the chronic stage (50 days of Kaolin injections).In the clinical study the patients with normal pressure hydrocephalus (NPH) underwent continuous monitoring of the intracranial pressure, CT cisternography as a study of CSF dynamics, MR imaging and T1, T2 measurements, Xe-CT blood flow measurements, and detailed mental evaluations before and after shunting. In typical NPH patients there were prolongation of T1, T2 values in MR imaging suggesting the increase in free water content in the periventricular white matter, marked disturbance of CSF dynamics high incidence of B waves, and derangement of cerebral blood flow. All these factors relative to the disturbance of CSF dynamics improved after shunting procedure suggesting that the disturbance of CSF dynamics may be the most basic causative factor in the pathophysiology of internal hydrocephalus.