Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Original Articles
Clinical Significance of the CSF Pulsation Flow Sign in the Foramen of Monro on FLAIR in Patients with Aneurysmal SAH -Preliminary Report-
Rie AOKIMasami SHIMODAShinri ODAMasaaki IMAIHideaki SHIGEMATSUMitsunori MATSUMAE
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JOURNAL OPEN ACCESS

2019 Volume 59 Issue 7 Pages 271-280

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Abstract

It is known that the cerebrospinal fluid (CSF) pulsation flow sign in the lateral ventricles directly above the foramen of Monro (CPF-M) on axial fluid attenuated inversion recovery (FLAIR) is a normal physiological finding as an artifact of FLAIR. In this study, whether CPF-M can be used as a neuroradiological finding related to pathological conditions in patients with acute aneurysmal subarachnoid hemorrhage (aSAH) was investigated. CPF-M-related clinical features were retrospectively evaluated in 147 aSAH patients who underwent adequate serial MRI examinations without massive intraventricular hemorrhage (IVH) of the lateral ventricle within 48 h of ictus. The frequency of the CPF-M in the control group was 32% (57/178), 33% (40/123), and 38% (45/117) for the normal control, chronic cerebral infarction, and deep white matter lesion (WML) groups, respectively. In aSAH patients, the overall prevalence of the CPF-M was 57% (84/147), significantly higher than in the three control groups. Multivariate analysis showed that age <70 years, lower IVH Hijdra score of the fourth ventricle, absence of T1-FLAIR mismatch, deep WMLs, old infarction, diffuse brain swelling, symptomatic delayed cerebral ischemia (DCI), shunt-dependent chronic hydrocephalus (SDCH), and favorable outcome were significantly associated with the CPF-M. Although limited to SAH patients without massive IVH of the lateral ventricles, one can conclude that, in acute aSAH, the presence of CPF-M on admission MRI suggests that the circulatory dynamics of the CSF from the basal cistern to the ventricles are approximately normal. Thus, this finding may appear to offer an indicator of a good outcome without DCI and SDCH.

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© 2019 by The Japan Neurosurgical Society

This article is licensed under a Creative Commons [Attribution-NonCommercial-NoDerivatives 4.0 International] license.
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