ISMRM22 - Intracranial Pressure

Joint Annual Meeting ISMRM-ESMRMB & ISMRT 31st Annual Meeting • 07-12 May 2022 • London, UK

Intracranial Pressure

Weekday Course

ORGANIZERS: Karin Markenroth Bloch, Olivier Balédent, Susie Huang

Wednesday, 11 May 2022

S11 (Breakout A)

16:45 - 18:45

Moderators:
Intracranial Pressure: Physiology: Kevin Chan

Skill Level: Basic to Intermediate

Session Number: W-05

Session Number: W-05

Overview
The intracranial pressure (ICP) is the result of a dynamic interplay of several physiological mechanisms; for example, arterial and venous blood flow, CSF flow, and respiration. If the balance is disturbed, the brain will be in a state of hyper- or hypotension, both causing clinical symptoms. This course will explain the physiology of ICP, how it can be measured with MRI, and give examples of various pathologies stemming from abnormal ICP.

Target Audience
Scientists and clinicians who wish to understand the physiology of intracranial pressure, how it can be imaged and measured, and in which pathologies this is relevant.

Educational Objectives
As a result of attending this course, participants should be able to:
- Describe the physiological mechanisms behind intracranial pressure;
- Explain how MR can be used to non-invasively measure intracranial pressure;
- Discuss the limits of this method, and how it relates to more invasive measurement techniques; and
- Identify pathologies related to changes in intracranial pressure and how to use MR in the diagnosis.

	Intracranial Pressure: Physiology
16:45		Physiology of Intracranial Flow & Pressure Video Permission Withheld Marek Czosnyka Cerebrospinal Fluid (CSF) flows continuously within all cavities of cerebrospinal space. Flow is slow, approximately 2000 times slower than Cerebral Blood Flow (CBF). Dynamic relationship between CBF and CSF circulation is complex, and involves basic physiological mechanism like cerebrovascular resistance, compartmental compliances, autoregulation of CBF, vascular impedance and critical closing pressure (CrCP). Proper functioning of CSF flow pathway is guaranteed by matching CSF production to absorption rate. This part of CSF steady circulation is easy to describe in a form of Davson's equation. Apart of circulation CSF displays some pulsatiles movments, which may be investigated using PCMRI.
17:15		Measuring Intracranial Flow & Pressure View the Presentation Anders Wåhlin We are now beginning to understand how intracranial pressure gradients, and intracranial pressure transients, propel the cerebrospinal fluid circulation and contributes to cerebrospinal fluid-based brain clearance. This talk reviews approaches to study cerebrospinal fluid flow and pulsatility across different frequency regimes of relevance (bulk flow, respiration, cardiac) and characterize the interplay between intracranial vascular and cerebrospinal fluid compartments. Special attention is devoted to the prospect of non-invasively measuring intracranial pulse pressure and pressure.
	Intracranial Pressure: Clinical Aspects
17:45		Normal-Pressure Hydrocephalus View the Presentation Madoka Nakajima Idiopathic normal pressure hydrocephalus (iNPH) is a condition resulting from impaired cerebrospinal fluid (CSF) absorption and secretion characterized by a triad of symptoms comprising dementia, gait disturbance (impaired trunk balance), and urinary incontinence.　The symptoms of iNPH can be reversed by improving CSF turnover through shunting. However, early diagnosis is essential as once neurodegeneration has progressed, pathological changes become irreversible and symptom improvement is minimal, even after shunting.　Combining a variety of diagnostic methods may lead to a more definitive diagnosis and accurate prediction of the prognosis following shunt treatment.
18:15		Advances in Imaging Spontaneous Intracranial Hypotension Video Unavailable John Benson, John Port