Reversible alterations of the neuronal activity in spontaneous intracranial hypotension.
OBJECTIVE
The aim of this article is to investigate the pathophysiology underlying the alternation of the cognitive function and neuronal activity in spontaneous intracranial hypotension (SIH).


METHODS
Fifteen patients with SIH underwent resting-state functional magnetic resonance imaging and working-memory (WM) test one day before and one month after a surgical operation. Alternation of the cognitive function and spontaneous neuronal activity measured as amplitude of the low-frequency fluctuations (ALFF) and the functional connectivity of the default-mode network (DMN) and frontoparietal networks (FPNs) were evaluated.


RESULTS
WM performance significantly improved post-operatively. Whole-brain linear regression analysis of the ALFF revealed a positive correlation between cognitive performance change and ALFF change in the precuneus while a negative correlation was found in the bilateral orbitofrontal cortices (OFCs) and right medial frontal cortex (MFC). The ALFF changes normalised with the WM performance improvement post-operatively. The FPN activity in the right OFC was also increased pre-operatively. Partial correlation analysis revealed a significant correlation between WM performance and right OFC activity controlled for right FPN activity.


CONCLUSIONS
The abnormal activity of the OFCs and MFC that is not originating from the synchronous intrinsic network activity, together with the decreased activity of the central node of the DMN, could lead to cognitive impairment in SIH that is reversible through restoration of the cerebrospinal fluid.
Department of Radiology, Graduate School of Medicine, University of Tokyo, Japan amemiya-tky@umin.ac.jp.
Shiori
S
Amemiya
Department of Neurosurgery, Sanno Hospital, Japan.
Koichi
K
Takahashi
Department of Neurosurgery, Sanno Hospital, Japan.
Tatsuo
T
Mima
Department of Radiology, Sanno Hospital, Japan.
Naoki
N
Yoshioka
22nd Century Medical and Research Center, University of Tokyo, Japan.
Soichiro
S
Miki
Department of Radiology, Graduate School of Medicine, University of Tokyo, Japan.
Kuni
K
Ohtomo
D000328:Adult; D001921:Brain / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D019585:Intracranial Hypotension / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged
Spontaneous intracranial hypotension; fMRI; spontaneous neuronal activity; working memory