September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Cranio-Spinal CSF Redistribution Before and Following Lumbar Puncture in Patients with Newly-Diagnosed Untreated Idiopathic Intracranial Hypertension
Author Affiliations & Notes
  • Byron L Lam
    Bascom Palmer Eye Institute, Miami, Florida, United States
  • Noam Alperin
    Radiology, University of Miami, Miami, Florida, United States
  • Jennifer Verriotto
    Bascom Palmer Eye Institute, Miami, Florida, United States
  • Joshua Pasol
    Bascom Palmer Eye Institute, Miami, Florida, United States
  • Bahareh Hassanzadeh
    Bascom Palmer Eye Institute, Miami, Florida, United States
  • Sean Gratton
    Bascom Palmer Eye Institute, Miami, Florida, United States
  • Sang Lee
    Radiology, University of Miami, Miami, Florida, United States
  • Ahmet M Bagci
    Radiology, University of Miami, Miami, Florida, United States
  • Footnotes
    Commercial Relationships   Byron Lam, None; Noam Alperin, None; Jennifer Verriotto, None; Joshua Pasol, None; Bahareh Hassanzadeh, None; Sean Gratton, None; Sang Lee, None; Ahmet Bagci, None
  • Footnotes
    Support  NANOS pilot grant, NIH Center Core Grant P30EY014801, Research to Prevent Blindness
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 4549. doi:
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      Byron L Lam, Noam Alperin, Jennifer Verriotto, Joshua Pasol, Bahareh Hassanzadeh, Sean Gratton, Sang Lee, Ahmet M Bagci; Cranio-Spinal CSF Redistribution Before and Following Lumbar Puncture in Patients with Newly-Diagnosed Untreated Idiopathic Intracranial Hypertension. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4549.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : The physiologic effect of lumbar puncture (LP) in idiopathic intracranial hypertension (IIH) has not been adequately studied and automated quantitation of cerebrospinal fluid (CSF) volumes by MRI is lacking. We performed a prospective observation clinical study to characterize the physiologic effect of LP by determining the change of cranio-spinal CSF redistribution before and after LP in untreated IIH patients. To achieve this aim, we developed a new automated method for delineating spinal CSF spaces.

Methods : The study subjects consists of 8 young overweight women with newly-diagnosed untreated IIH (Age 29±5.9 years, BMI 34±6.7). Research cranio-spinal MRIs were performed immediately before and immediately after the diagnostic LP to establish IIH (opening pressure 33±9.1 cm water). MR imaging included T1W MPRAGE and T2W SPACE sequences of the brain and 2 separate T2W SPACE sequences covering the upper and lower portions of the spinal canal. Cranio-spinal CSF volumes prior and following LP were compared to the amount of CSF withdrawn.

Results : LP results in reduced spinal CSF volume localized near the region of the LP without change in cranial CSF volume. Spinal CSF and cord volumetric automated measurements were highly reproducible with mean variability of less than 1%, -0.7±1.4%, -0.7±1.0%, respectively. The pre-to-post CSF withdrawal differences in the cranio-spinal CSF volumes were consistently smaller and strongly correlated with the CSF amounts removed (R=0.86,p=0.006). The smaller measured pre-to-post LP CSF differences compared to the CSF amount withdrawn can be reconciled assuming a net CSF formation of 0.41±0.18ml/min.

Conclusions : Despite the high intracranial pressure, the drop in intracranial pressure from LP in IIH is related to the immediate increase in spinal canal compliance from CSF removal near the spinal region of the LP without change in cranial CSF volume. Our findings enhance the understanding of the CSF flow dynamics of LP in IIH, and the automated method developed permit future longitudinal studies to assess cranio-spinal CSF in IIH patients.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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