Cisternographic Pattern of Spontaneous Liquoral Hypotension

We describe five cases of headache due to spontaneous liquoral hypotension, the syndrome comprising sudden, intense and oppressive orthostatic holocranial headache. The headache improved in the recumbent position and was accompanied by nausea and sometimes vomiting. There was no history of lumbar puncture or previous trauma. CSF tension was low or negative. The CSF showed a raised protein content and increased red and white cell counts. CT scan was normal or showed a slit ventricular system. Improvement was complete three to eight weeks from onset. The treatment consisted of bed rest and oral and parenteral fluid replacement. An isotope cisternography carried out in all patients while the headache was present showed a cisternographic pattern characterized by a combination of premature elimination and failure to detect the isotope at the cerebral convexity. Scan images did not show CSF leakage at any site. This stereotyped reaction pattern suggests that CSF hyperabsorption is the most likely pathophysiological mechanism of this entity.

ICP patterns and isotope cisternography in patients with communicating hydrocephalus following rupture of intracranial aneurysm

✓ Intracranial pressure (ICP) was continuously recorded, isotope cisternography was performed, and the ventricular system size was evaluated on serial computerized tomography scans in 39 patients. All of these patients had communicating hydrocephalus after subarachnoid hemorrhage (SAH) from rupture of an intracranial aneurysm. The studies were carried out in both the acute stage (within 7 days after SAH) and the communicating hydrocephalus stage. In patients in the acute stage who had no ventricular dilatation, but who later developed communicating hydrocephalus, the resting ICP was high, and an ICP pattern of B-wave activity was seen; there was no delay in cerebrospinal fluid (CSF) absorption on isotope cisternography. Patients with communicating hydrocephalus in whom ICP recordings were started within 63 days after SAH had a pattern of plateau waves in conjunction with B-waves, and there was a marked delay in CSF circulation. In general, patients with higher resting ICP's had more frequent ICP irregularities. Patients with communicating hydrocephalus in whom recordings were begun more than 6 months after SAH had a low and flat ICP pattern, and there was no delay in CSF absorption in spite of bilateral convexity blocks on isotope cisternography. The results suggest that the ICP pattern of plateau waves in conjunction with B-waves can be regarded as a sign of delayed CSF absorption; hence, shunting procedures may be indicated in patients with plateau waves in conjunction with B-waves visualized on continuous ICP recordings.

Evidence of Disturbed CSF Circulation and Brain Atrophy in Cases of Schizophrenic Psychosis

SummaryThe cerebrospinal fluid (CSF) circulation was studied with isotope cisternography in 30 patients with a schizophrenic type of psychosis. All had previously received neuroleptic treatment. Disturbed CSF circulation was found in 10 cases. In four of these, persistent intraventricular radioactivity was observed as well as partly obstructed CSF spaces. In the other six cases a slow CSF circulation was noted as well as evidence of partly obstructed CSF spaces especially of the upper posterior frontal region. Signs of atrophy of the cortex and vermis were found on CT scan in 10 cases. In four of these subjects a local atrophy was noticed in the upper posterior frontal cortex and around the frontal part of the interhemispheric fissure. Seventeen of the patients (57 per cent) had pathological findings at isotope cisternography and/or at CT. Disturbed circulation did not correlate with CT-findings, age, duration of psychosis, alcohol abuse, drug consumption or family history for psychosis. CT evidence of brain atrophy was significantly related to nonfamilial type of psychosis.

Mechanisms of Hydrocephalus in Cerebral Cysticercosis: Implications for Therapy

Patients with hydrocephalus secondary to cerebral cysticercosis are a highly heterogeneous group. The mechanisms of hydrocephalus in these patients are multiple. Intraventricular cysts may be found in the 3rd and 4th ventricles, the sylvian aqueduct, and the foramen of Monro. Intraventricular cysts can be suspected when the 3rd and 4th ventricles or aqueduct remain enlarged despite shunting. Intraventricular contrast medium demonstrates the presence of the parasites. The intraventricular cysts should be removed surgically. Hydrocephalus due to cisternal cysticercosis can be diagnosed by isotope cisternography. These patients should receive shunts, but the long term prognosis is probably poor. Guidelines for the management of hydrocephalus due to cysticercosis are suggested.