Colour doppler imaging for diagnosis of intracranial hypotension
1Neurological Institute, Veterans General Hospital-Taipei, Taiwan, Republic of China.
Insights
Colour Doppler Flow Imaging (CDFI) of the superior ophthalmic vein offers a non-invasive method to diagnose intracranial hypotension by measuring blood flow changes. This technique aids in confirming low-pressure headaches and monitoring treatment effectiveness.
Area of Science:
- Neuroimaging
- Vascular Ultrasound
- Neurology
Background:
- Intracranial hypotension diagnosis traditionally relies on invasive cerebrospinal fluid pressure measurement.
- There is a need for non-invasive diagnostic tools for intracranial hypotension.
Purpose of the Study:
- To evaluate Colour Doppler Flow Imaging (CDFI) for assessing superior ophthalmic vein blood flow.
- To determine CDFI's utility in diagnosing intracranial hypotension.
Main Methods:
- 25 patients with suspected intracranial hypotension underwent CDFI of the superior ophthalmic vein.
- Cerebrospinal fluid pressure was measured via lumbar puncture.
- Brain MRI and sonographic examinations were performed.
- Control groups included healthy individuals and patients without low-pressure headache.
Main Results:
- Superior ophthalmic vein diameter was significantly larger in patients with intracranial hypotension compared to controls (3.9 mm vs. 2.6-2.7 mm).
- Mean maximum flow velocity was significantly higher in the intracranial hypotension group (17.0 cm/s vs. 7.3-7.9 cm/s).
- Treatment with epidural blood patch reversed these flow changes and relieved symptoms.
Conclusions:
- CDFI of the superior ophthalmic vein is a practical, simple, and non-invasive diagnostic method for suspected intracranial hypotension.
- This ultrasound technique can aid in the diagnosis and management of intracranial hypotension.
Background:
Measurement of CSF pressure is the only known way to confirm the diagnosis of intracranial hypotension. We aimed to assess colour doppler flow imaging (CDFI) for measurement of blood flow of the superior ophthalmic vein for the diagnosis of intracranial hypotension.
Methods:
We enrolled 25 consecutive patients with orthostatic headache who had clinical features of intracranial hypotension. We defined low-pressure headache as cerebrospinal-fluid pressure below 60 mm H2O. We used CDFI to measure the diameter and maximum flow velocity of the superior ophthalmic vein in all patients. Magnetic resonance imaging of the brain and lumbar puncture with measurement of cerebrospinal-fluid pressure within 24 h were also done after sonographic examination. The control group comprised 13 healthy individuals of a similar age; in addition, those patients who had orthostatic headache without low pressure served as a control group for the patients.
Findings:
Of the 25 patients recruited for this study, 13 satisfied the criteria for low-pressure headache. The remaining 12 patients with normal cerebrospinal-fluid pressure had transformed migraine (five patients) or chronic tension-type headache (seven patients), and therefore served as the control group for the patients. The mean diameter of the superior ophthalmic vein was substantially larger in the patients with intracranial hypotension (3.9 [SD 0.2] mm) than in the healthy controls (2.6 [0.4] mm) and the controls from the patients' group (2.7 [0.2] mm) (p<0.0001). The mean maximum flow velocity was significantly higher in the intracranial-hypotension group (17.0 [SD 3.4] cm/s) than in the healthy controls (7.9 [1.1] cm/s) and the other patients (7.3 [1.7] cm/s) (p<0.0001). Seven patients with intracranial hypotension were reassessed after treatment with epidural blood patch. After this treatment the clinical symptoms were relieved and there was a striking reversal of the superior ophthalmic vein flow.
Interpretation:
CDFI to measure blood flow of the superior ophthalmic vein provides a practical, simple, and non-invasive diagnostic method for suspected intracranial hypotension.
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