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Decrease in pulsatile flow in the anterior cerebral arteries in infantile hydrocephalus

A Hill, J J Volpe

    Pediatrics
    |January 1, 1982
    PubMed
    Summary
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    Ventriculomegaly, not just intracranial pressure, significantly impairs cerebral artery blood flow in infants with hydrocephalus. This pulsatility index (PI) can help monitor brain injury risk.

    Area of Science:

    • Pediatric Neurology
    • Neurocritical Care
    • Cerebrovascular Physiology

    Background:

    • Hydrocephalus in infants, often caused by intraventricular hemorrhage, can lead to increased intracranial pressure (ICP) and affect cerebral blood flow.
    • Ventriculomegaly, the enlargement of brain ventricles, is a key feature of hydrocephalus and its impact on cerebral hemodynamics requires further investigation.

    Purpose of the Study:

    • To investigate the effect of ventriculomegaly and elevated intracranial pressure (ICP) on pulsatile flow in the anterior cerebral artery (ACA) in infants with hydrocephalus.
    • To determine if the pulsatility index (PI) can serve as a sensitive indicator of compromised cerebral blood flow and potential brain injury.

    Main Methods:

    • A noninvasive Doppler technique was used to assess pulsatile flow in the ACA of 11 infants diagnosed with hydrocephalus.

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  • The pulsatility index (PI), calculated from systolic and diastolic flow amplitudes, was measured and correlated with the degree of ventriculomegaly and ICP levels.

    • Main Results:

    • All 11 infants exhibited elevated PI, indicating impaired pulsatile flow, and all had significant ventriculomegaly.
    • Elevated ICP was present in most patients, but two with ventriculomegaly and normal ICP also showed elevated PI, suggesting ventriculomegaly is a critical factor.
    • Treatment of ventriculomegaly led to a decrease in PI, while untreated patients had poor outcomes, including mortality.

    Conclusions:

    • Ventriculomegaly, more so than elevated ICP, appears to be a critical determinant of impaired pulsatile flow in the ACA in infants with hydrocephalus.
    • The pulsatility index (PI) may be a valuable, noninvasive parameter for monitoring cerebral hemodynamic changes, predicting ischemic injury, and guiding intervention timing in pediatric hydrocephalus.