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首页> 外文学位 >Using multi-modality measurements to investigate intracranial pressure waveform morphology in patients with normal pressure hydrocephalus.
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Using multi-modality measurements to investigate intracranial pressure waveform morphology in patients with normal pressure hydrocephalus.

机译：使用多模态测量来调查正常压力脑积水患者的颅内压力波形形态。

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摘要

The dynamic environment of the cranial vault relies on normal brain pulsatility to maintain homeostasis. Small deviations in pressure or flow of either blood or cerebrospinal fluid (CSF) can drastically alter normal brain function. This thesis will investigate alterations in brain pulsatility in normal pressure hydrocephalus (NPH) patients; however, many of the conclusions/analysis methods have a broader impact and can be applied to other neurologic conditions, including traumatic brain injury and subarachnoid hemorrhage. Invasive intracranial pressure (ICP) monitoring and noninvasive Phase-contrast MRI (PC-MRI) will be used to measure brain pulsatility for this thesis, which is divided into three sections with three specific aims. Study 1: It is commonly accepted that there is some degree of CSF dysfunction in NPH. The first study investigates the stroke volume, latency, and variability changes that occur in the cerebral aqueduct and prepontine cistern of NPH patients and age-matched controls. Results show significant alterations in all aspects of CSF dynamics, which suggests decrease cisternal buffering, decreased compliance, and increased variability in the NPH cohort. Study 2: Differentiating shunt responders and non-responders has been a cornerstone of NPH research for over 50 years. Several aspects of ICP monitoring have been investigated as possible prognostic tests for NPH; however, results remain inconsistent and inaccurate. The advanced morphological analysis techniques used in this study show higher accuracy than traditional ICP analysis. These features, once further validated, could replace existing methods for more expensive, less accurate shunt selections. Study 3: Changes in pressure and flow dominate regulation of the internal dynamic environment of the brain; despite the physical relationship between the two phenomena, little is known about their impact on one another. Using CSF flow measured by PC-MRI, regional and individual ICP metrics that correlate with CSF flow were easily identified. This is a first step toward a better understanding of the characteristic peaks of the ICP pulse pressure waveform. Conclusion: The aforementioned studies reveal that modest changes in brain pulsatility can be detected in NPH patients. Although it is unlikely that these changes are the sole reason for the symptoms of NPH, these studies make important advances in understanding the pathoetiology of NPH. These discoveries need further investigation, but have the potential to change the way NPH is diagnosed and treated in the future.
机译：颅穹顶的动态环境依靠正常的大脑搏动来维持体内平衡。血液或脑脊液（CSF）的压力或流量的微小偏差会大大改变正常的大脑功能。本论文将研究常压性脑积水（NPH）患者的脑搏动变化。然而，许多结论/分析方法具有更广泛的影响，并可应用于其他神经系统疾病，包括颅脑外伤和蛛网膜下腔出血。本文采用有创颅内压（ICP）监测和无创相衬MRI（PC-MRI）来测量脑搏动性，该研究分为三个部分，三个目标。研究1：公认的是NPH中存在一定程度的CSF功能障碍。第一项研究调查了NPH患者和年龄匹配的对照组的脑导水管和脑桥前池的卒中量，潜伏期和变异性变化。结果显示，脑脊液动力学各方面均发生了显着变化，这表明脑池缓冲液减少，顺应性降低以及NPH队列的变异性增加。研究2：在50多年来，区分并联响应器和非响应器一直是NPH研究的基石。已经对ICP监测的几个方面进行了研究，以作为NPH的可能预后测试。但是，结果仍然不一致且不准确。本研究中使用的高级形态分析技术显示出比传统ICP分析更高的准确性。这些功能一旦得到进一步验证，便可以替代现有方法，从而实现更昂贵，更不准确的并联选择。研究3：压力和流量的变化主导着大脑内部动态环境的调节；尽管这两种现象之间存在物理关系，但人们对它们彼此之间的影响知之甚少。使用通过PC-MRI测量的CSF流量，可以轻松识别与CSF流量相关的区域和单个ICP指标。这是迈向更好地了解ICP脉冲压力波形特征峰的第一步。结论：上述研究表明，NPH患者可检测到适度的脑搏动变化。尽管这些变化不太可能是NPH症状的唯一原因，但这些研究在理解NPH的病理学方面取得了重要进展。这些发现需要进一步调查，但有可能改变日后NPH的诊断和治疗方式。

著录项

  • 作者

    Hamilton, Robert Benjamin.;

  • 作者单位

    University of California, Los Angeles.;

  • 授予单位 University of California, Los Angeles.;
  • 学科 Engineering Biomedical.
  • 学位 Ph.D.
  • 年度 2014
  • 页码 142 p.
  • 总页数 142
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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