title: Increased pulsatile intracranial pressure in patients with symptomatic pineal cysts and magnetic resonance imaging biomarkers indicative of central venous hypertension.
abstract: BACKGROUND
  In symptomatic individuals with non-hydrocephalic pineal cysts (PCs), it remains controversial what causes the symptoms. Based on magnetic resonance imaging (MRI) biomarkers, we proposed that PC-associated crowding of the pineal recess may cause central venous hypertension. The aim of this study was to compare pulsatile and static ICP in patients with PCs and chronic daily headache (CDH), and compare ICP data in PC patients with the previously identified MRI biomarkers.
  
  
  METHODS
  All patients assessed with over-night ICP monitoring for PCs or CDH who had been ruled out for idiopathic intracranial hypertension without papilledema (IIHWOP) were retrieved from the database. The symptoms as well as the pulsatile and static ICP scores were compared between the PC and CDH patients, and ICP scores were compared with the MRI biomarkers indicative of central venous hypertension.
  
  
  RESULTS
  The pulsatile ICP was significantly increased in the symptomatic patients with non-hydrocephalic PCs as compared to the CDH patients. Pulsatile ICP was significantly increased in the individuals with PC-grades 3-4, who had MRI biomarkers indicative of central venous hypertension. The tectum-splenium-cyst ratio correlated positively with pulsatile ICP and an index of thalamic edema.
  
  
  CONCLUSIONS
  Pulsatile ICP is increased in symptomatic patients with PCs and imaging evidence of central venous hypertension, supporting the hypothesis that PC-induced crowding of the pineal recess and venous obstruction may cause a central venous hypertension syndrome.
authors.affiliation: Dept. of Neurosurgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway. Electronic address: p.k.eide@medisin.uio.no.
authors.forename: Per Kristian
authors.initials: PK
authors.lastname: Eide
authors.affiliation: Dept. of Radiology and Nuclear Medicine, Oslo University Hospital- Rikshospitalet, Oslo, Norway.
authors.forename: Geir
authors.initials: G
authors.lastname: Ringstad
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000503:physiopathology; D001932:Brain Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002496:Central Venous Pressure; D003560:Cysts / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology*; D007427:Intracranial Pressure; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D055815:Young Adult
keywords: Central venous hypertension; MRI; Pineal cysts; Pulsatile intracranial pressure; Symptomatic