|ECR 2019 / C-3604|
|Neuroimaging of the main Cerebrospinal Fluid Disorders|
The dynamics of the CSF have a great importance, among other reasons, due to the impact it has on intracranial pressure. This dynamic depends mainly on the formation, circulation and reabsorption of the CSF.
The alterations produced in any of the elements of the circuit that the LCR performs will cause defined entities that can mostly be identified by means of image tests. The main entities are hydrocephalus, CSF hypotension syndrome and cerebral pseudotumour:
- Hydrocephalus results from the imbalance between the formation (always constant) and drainage (hampered by defects in circulation or absorption) of CSF which leads to a net accumulation of fluid within the ventricles with the consequent increase in intracranial pressure. There are a great variety of etiopathogenic classifications of this entity (see table).
- IHS is caused by cerebrospinal fluid leaking from the subarachnoid space into the epidural space due to a defect in the dura.
- Cerebral pseudotumour syndrome (PTC) consists of a clinical picture of intracranial hypertension (ICH) with no demonstrable cause. It can be really idiopathic or secondary to certain conditions.
Broadly speaking, the clinical characteristics of each entity are:
- CSF hypotension syndrome: it is characterized by the appearance of a holocranial headache with a clear postural relationIHSp (orthostatic headache). The headache can be associated with vertigo, nausea, vomiting, profuse sweating, blurred vision, tinnitus.
- Hydrocephalus: Bifrontal headache with sometimes papilledema and optical atrophy, paresis of VI pair and Parinaud sign (Impaired vertical gaze but intact horizontal gaze), endocrine alterations, hypothalamus-hypophysis affectation, mental alterations, gait ataxia, sphincter decontrol and altered level of consciousness in acute cases.
- Pseudotumor cerebri syndrome: Headache (present in almost all patients), pulsating tinnitus, visual acuity impairment, transient loss of vision, photopsies, alterations of campimetry, paralysis of the cranial nerve VI. The main morbidity factor of this disease is the decrease in visual acuity, which in extreme cases can lead to blindness.
Computerized axial tomography is useful in the urgent diagnosis of hydrocephalus and cerebral hypotension syndrome. However, magnetic resonance imaging is the technique of choice for evaluating disorders of the dynamics of the CSF.
Thematically related posters
ECR 2019 / C-3656
Differential diagnosis of intracranial ring-enhancing lesions: a practical approach