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Brain stiffness following recovery in a patient with an episode of low-pressure hydrocephalus: case report

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Abstract

The authors describe a follow-up to a case of a 19-year-old female with shunted aqueductal stenosis who presented with low-pressure hydrocephalus during a shunt malfunction. Shortly after management with CSF drainage at negative pressure, a magnetic resonance elastography scan was performed and revealed very low brain stiffness (high compliance). Here we present the case of the same patient seen 2 years later, now 21 years old, who again received a magnetic resonance elastography scan after receiving treatment for another shunt malfunction, this time with high intracranial pressure. This scan revealed recovery of brain stiffness to a near normal value for the patients’ age. This observation suggests the low brain stiffness observed during the low-pressure hydrocephalus event is reversible. The authors discuss these findings in relation to biomechanical hypotheses of low-pressure hydrocephalus.

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Abbreviations

CSF:

Cerebrospinal fluid

LPH:

Low-pressure hydrocephalus

MRE:

Magnetic resonance elastography

References

  1. Pang D, Altschuler E (1994) Low-pressure hydrocephalic state and viscoelastic alterations in the brain. Neurosurgery. 35(4):643–656. https://doi.org/10.1227/00006123-199410000-00010

    Article  CAS  PubMed  Google Scholar 

  2. Strand A, Balise S, Leung LJ, Durham S (2018) Low-pressure hydrocephalus: a case report and review of the literature. World Neurosurg 109:e131–e135. https://doi.org/10.1016/j.wneu.2017.09.120

    Article  PubMed  Google Scholar 

  3. Akins PT, Guppy KH (2011) The Genesis of Low Pressure Hydrocephalus 15:461–468. https://doi.org/10.1007/s12028-011-9543-6

    Article  Google Scholar 

  4. Lesniak MS, Clatterbuck RE, Rigamonti D, Williams MA (2002) Low pressure hydrocephalus and ventriculomegaly: hysteresis, non-linear dynamics, and the benefits of CSF diversion. Br J Neurosurg 16(6):555–561. https://doi.org/10.3109/02688690209168360

    Article  CAS  PubMed  Google Scholar 

  5. Dias MS, Li V, Pollina J (1999) Low-pressure shunt “malfunction” following lumbar puncture in children with shunted obstructive hydrocephalus. Pediatr Neurosurg 30(3):146–150. https://doi.org/10.1159/000028783

    Article  CAS  PubMed  Google Scholar 

  6. Vassilyadi M, Farmer J-P, Montes JL (1995) Negative-pressure hydrocephalus. J Neurosurg 83(C):486–490

    Article  CAS  Google Scholar 

  7. Rekate HL (2019) Low or negative pressure hydrocephalus demystified. World Neurosurg 128:287–288. https://doi.org/10.1016/j.wneu.2019.05.032

    Article  PubMed  Google Scholar 

  8. Olivero WC, Wszalek T, Wang H, Farahvar A, Rieth SM, Johnson CL (2016) Magnetic resonance elastography demonstrating low brain stiffness in a patient with low-pressure hydrocephalus: case report. Pediatr Neurosurg 51(5):257–262. https://doi.org/10.1159/000445900

    Article  PubMed  Google Scholar 

  9. Johnson CL, Holtrop JL, McGarry MDJ et al (2014) 3D multislab, multishot acquisition for fast, whole-brain MR elastography with high signal-to-noise efficiency. Magn Reson Med 71(2):477–485. https://doi.org/10.1002/mrm.25065

    Article  PubMed  PubMed Central  Google Scholar 

  10. McGarry MDJ, Van Houten EEW, Johnson CL et al (2012) Multiresolution MR elastography using nonlinear inversion. Med Phys 39(10):6388–6396. https://doi.org/10.1118/1.4754649

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Johnson CL, Schwarb H, McGarry MDJ et al (2016) Viscoelasticity of subcortical gray matter structures. Hum Brain Mapp 37(12):4221–4233. https://doi.org/10.1002/hbm.23314

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hiscox LV, Johnson CL, McGarry MDJ et al (2018) High-resolution magnetic resonance elastography reveals differences in subcortical gray matter viscoelasticity between young and healthy older adults. Neurobiol Aging 65:158–167. https://doi.org/10.1016/j.neurobiolaging.2018.01.010

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hiscox LV, Johnson CL, Barnhill E, McGarry MDJ, Huston J 3rd, van Beek EJR, Starr JM, Roberts N (2016) Magnetic resonance elastography (MRE) of the human brain: technique, findings and clinical applications. Phys Med Biol 61(24):R401–R437. https://doi.org/10.1088/0031-9155/61/24/R401

    Article  PubMed  Google Scholar 

  14. Murphy MC, Huston J, Ehman RL (2019) MR elastography of the brain and its application in neurological diseases. Neuroimage. 187:176–183. https://doi.org/10.1016/j.neuroimage.2017.10.008

    Article  PubMed  Google Scholar 

  15. Shapiro K, Marmarou A, Shulman K (1980) Characterization of clinical CSF dynamics and neural axis compliance using the pressure-volume index: I. the normal pressure-volume index. Ann Neurol 7(6):508–514. https://doi.org/10.1002/ana.410070603

    Article  CAS  PubMed  Google Scholar 

  16. Arani A, Min HK, Fattahi N, Wetjen NM, Trzasko JD, Manduca A, Jack CR Jr, Lee KH, Ehman RL, Huston J III (2018) Acute pressure changes in the brain are correlated with MR elastography stiffness measurements: initial feasibility in an in vivo large animal model. Magn Reson Med 79(2):1043–1051. https://doi.org/10.1002/mrm.26738

    Article  CAS  PubMed  Google Scholar 

  17. Kolipaka A, Wassenaar PA, Cha S, Marashdeh WM, Mo X, Kalra P, Gans B, Raterman B, Bourekas E (2018) Magnetic resonance elastography to estimate brain stiffness: measurement reproducibility and its estimate in pseudotumor cerebri patients. Clin Imaging 51(February):114–122. https://doi.org/10.1016/j.clinimag.2018.02.005

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hatt A, Cheng S, Tan XK, Sinkus R, Bilston LE (2015) MR elastography can be used to measure brain stiffness changes as a result of altered cranial venous drainage during jugular compression. Am J Neuroradiol 36(10):1971–1977. https://doi.org/10.3174/ajnr.A4361

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Funding

The Carle Neuroscience Institute of the Carle Foundation Hospital provided support for this research.

Author information

Authors and Affiliations

  1. Carle Neuroscience Institute, Carle Foundation Hospital, Urbana, IL, USA

    William C Olivero & Arundhati Biswas

  2. Department of Surgery, University of Illinois College of Medicine, Urbana, IL, USA

    William C Olivero

  3. Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA

    William C Olivero, Tracey M Wszalek & Bradley P Sutton

  4. Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA

    Bradley P Sutton

  5. Department of Biomedical Engineering, University of Delaware, Newark, DE, USA

    Curtis L Johnson

Authors
  1. William C Olivero
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  2. Arundhati Biswas
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  3. Tracey M Wszalek
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  4. Bradley P Sutton
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  5. Curtis L Johnson
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Contributions

WCO conceived the research; WCO, AB, TMW, and BPS collected the data; CLJ analyzed the data; WCO, AB, and CLJ wrote the manuscript; and all authors edited and approved the final manuscript.

Corresponding authors

Correspondence to William C Olivero or Curtis L Johnson.

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Statement of ethics

This research was performed ethically in accordance with the World Medical Association Declaration of Helsinki. The Institutional Review Board of Carle Foundation Hospital approved this research. The patient provided informed, written consent to participate in this research.

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The authors report no conflicts of interest regarding the material presented in this work.

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Olivero, W.C., Biswas, A., Wszalek, T.M. et al. Brain stiffness following recovery in a patient with an episode of low-pressure hydrocephalus: case report. Childs Nerv Syst 37, 2695–2698 (2021). https://doi.org/10.1007/s00381-020-04922-x

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  • DOI: https://doi.org/10.1007/s00381-020-04922-x

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