Summary
RIHSA cisternography was performed in 47 patients after head injuries. Five patterns of abnormal C.S.F. flow and absorption were distinguished: 1. complete obstruction of the subarachnoid space over both cerebral convexities, with ventricular filling; 2. partial obstruction of the subarachnoid space over both cerebral convexities, with transient or persistent ventricular filling; 3. obstruction of the subarachnoid space over one brain convexity, with transient or persistent ventricular filling; 4. obstruction of the subarachnoid space over one convexity without ventricular filling; 5. delayed absorption of C.S.F. with a normal pattern of C.S.F. pathways. Patterns 2–5 are considered to be intermediary stages in the development or regression of hydrocephalus, which if progressive causes the final result observed in pattern 1.-In the abnormal scintigrams the subarachnoid space over one or both cerebral convexities is obstructed, the normal flow of C.S.F. to the absorption areas around the superior sagittal sinus is disturbed, and alternative mechanisms of absorption through the walls of the cerebral ventricles come into play. These abnormal C.S.F. dynamics are reversible. The significance of these observations in the context of possible ventriculo-atrial shunting is discussed.
Résumé
La cisternographie à l'aide de RISA fut pratiquée chez 47 traumatisés crâniens. On put observer cinq groupes de circulation et d'absorption anormale du LCR: 1. Occlusion complète de l'espace sous-arachnoïdien sur les deux convexités cérébrales et remplissage ventriculaire; 2. Occlusion partielle de l'espace sous-arachnoïdien sur les deux convexités cérébrales et remplissage ventriculaire passager ou persistant; 3. Occlusion de l'espace sous-arachnoïdien sur l'une des convexités cérébrales et remplissage ventriculaire passager ou persistant; 4. Occlusion de l'espace sous-arachnoïdien sur une convexité sans remplissage ventriculaire; 5. Absorption ralentie du LCR avec circulation normale du liquide céphalorachidien. Les variantes 2–5 peuvent être considérées comme étapes intermédiaires de formation ou de régression d'hydrocéphalie qui, si elle est progressive, aboutit ou résultat du groupe 1.-Sur les scintigrammes anormaux, l'espace sous-arachnoïdien sur l'une ou sur les deux complexités cérébrales est fermé, le flux normal du LCR au niveau des aires d'absorption du sinus sagittal supérieur est perturbé et les mécanismes alternatifs d'absorption à travers les parois des ventricules cérébraux entrent en jeu. Ces dynamiques anormales du LCR sont réversibles. Les auteurs discutent la significantion de ces observations dans le contexte d'un éventuel shunt ventriculoatrial.
Zusammenfassung
Die Rihsa-Cisternographie wurde an 47 Patienten nach einem Schädeltrauma durchgeführt. Dahei ließen sich 5 Gruppen von pathologischen Veränderungen der Liquor-Dynamik feststellen. Die einzelnen Gruppen werden beschrieben und mit entsprechenden Abbildungen belegt.
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Front, D., Beks, J.W.F., Georganas, C.L. et al. Abnormal patterns of cerebrospinal fluid flow and absorption after head injuries; Diagnosis by isotope cisternography. Neuroradiology 4, 6–13 (1972). https://doi.org/10.1007/BF00344802
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DOI: https://doi.org/10.1007/BF00344802