title: Cerebrospinal fluid and blood flow patterns in idiopathic normal pressure hydrocephalus.
abstract: OBJECTIVE
  Increased aqueduct cerebrospinal fluid (CSF) flow pulsatility and, recently, a reversed CSF flow in the aqueduct have been suggested as hallmarks of idiopathic normal pressure hydrocephalus (INPH). However, these findings have not been adequately confirmed. Our objective was to investigate the flow of blood and CSF in INPH, as compared to healthy elderly, in order to clarify which flow parameters are related to the INPH pathophysiology.
  
  
  METHODS
  Sixteen INPH patients (73 years) and 35 healthy subjects (72 years) underwent phase-contrast magnetic resonance imaging (MRI). Measurements included aqueduct and cervical CSF flow, total arterial inflow (tCBF; i.e. carotid + vertebral arteries), and internal jugular vein flow. Flow pulsatility, net flow, and flow delays were compared (multiple linear regression, correcting for sex and age).
  
  
  RESULTS
  Aqueduct stroke volume was higher in INPH than healthy (148±95 vs 90±50 mL, P<.05). Net aqueduct CSF flow was similar in magnitude and direction. The cervical CSF stroke volume was lower (P<.05). The internal carotid artery net flow was lower in INPH (P<.05), although tCBF was not. No differences were found in internal jugular vein flow or flow delays.
  
  
  CONCLUSIONS
  The typical flow of blood and CSF in INPH was mainly characterized by increased CSF pulsatility in the aqueduct and reduced cervical CSF pulsatility. The direction of mean net aqueduct CSF flow was from the third to the fourth ventricle. Our findings may reflect the altered distribution of intracranial CSF volume in INPH, although the causality of these relationships is unclear.
authors.affiliation: Department of Radiation Sciences, Umeå University, Umeå, Sweden.|Centre for Biomedical Engineering and Physics, Umeå University, Umeå, Sweden.
authors.forename: S
authors.identifier: http://orcid.org/0000-0002-1454-4725
authors.initials: S
authors.lastname: Qvarlander
authors.affiliation: Department of Radiation Sciences, Umeå University, Umeå, Sweden.|Centre for Biomedical Engineering and Physics, Umeå University, Umeå, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Ambarki
authors.affiliation: Department of Radiation Sciences, Umeå University, Umeå, Sweden.|Umeå Centre for Functional Brain Imaging, Umeå University, Umeå, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Wåhlin
authors.affiliation: Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Jacobsson
authors.affiliation: Department of Radiation Sciences, Umeå University, Umeå, Sweden.
authors.forename: R
authors.initials: R
authors.lastname: Birgander
authors.affiliation: Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Malm
authors.affiliation: Department of Radiation Sciences, Umeå University, Umeå, Sweden.|Centre for Biomedical Engineering and Physics, Umeå University, Umeå, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Eklund
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity / Q000502:physiology*; D002535:Cerebral Aqueduct / Q000000981:diagnostic imaging* / Q000502:physiology*; D002552:Cerebral Ventricles / Q000503:physiopathology; D002555:Cerebrospinal Fluid / Q000502:physiology*; D005260:Female; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011673:Pulsatile Flow / Q000502:physiology; D012189:Retrospective Studies; D016037:Single-Blind Method
keywords: aqueduct flow; cerebral blood flow; cerebrospinal fluid; dementia; normal pressure hydrocephalus; phase-contrast magnetic resonance imaging