Intracranial venous blood flow in idiopapathic and secondary intracranial hypertension – hemodynamic impact of normalization of cerebro-spinal fluid pressure

We demonstrated the interaction of cerebrospinal fluid (CSF) pressure, venous volumetry, venous hemodynamics and optic nerve sheath diameter (ONSD) using multiparametric brain MRI. Closure of CSF leaks in spontaneous intracranial hypotension patients resulted in symptoms suggestive of increased intracranial pressure and caused a subsequent decrease of intracranial venous volume and of blood flow within the superior sagittal sinus while ONSD increased. In contrast, blood flow parameters from 4D flow MRI did not discriminate idiopathic intracranial hypertension, spontaneous intracranial hypotension and controls as hemodynamics at baseline overlapped at most vessel cross-sections between groups.