Brain stiffness following recovery in a patient with an episode of low-pressure hydrocephalus: case report
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CASE REPORT
Brain stiffness following recovery in a patient with an episode of low-pressure hydrocephalus: case report William C Olivero 1,2,3 & Arundhati Biswas 1 & Tracey M Wszalek 3 & Bradley P Sutton 3,4 & Curtis L Johnson 5 Received: 24 June 2020 / Accepted: 5 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The authors describe a follow-up to a case of a 19-year-old female with shunted aqueductal stenosis who presented with lowpressure hydrocephalus during a shunt malfunction. Shortly after management with CSF drainage at negative pressure, a magnetic resonance elastography scan was performed and revealed very low brain stiffness (high compliance). Here we present the case of the same patient seen 2 years later, now 21 years old, who again received a magnetic resonance elastography scan after receiving treatment for another shunt malfunction, this time with high intracranial pressure. This scan revealed recovery of brain stiffness to a near normal value for the patients’ age. This observation suggests the low brain stiffness observed during the lowpressure hydrocephalus event is reversible. The authors discuss these findings in relation to biomechanical hypotheses of lowpressure hydrocephalus. Keywords Low-pressure hydrocephalus . Elastography . Stiffness . Compliance
Abbreviations CSF Cerebrospinal fluid LPH Low-pressure hydrocephalus MRE Magnetic resonance elastography
Introduction Low-pressure hydrocephalus (LPH) is a rare condition where cerebrospinal fluid (CSF) drains at only very low, or even * William C Olivero [email protected]
negative, shunt pressure in addition to ventriculomegaly and traditional symptoms of hydrocephalus [1, 2]. Etiological theories of LPH generally focus on biomechanical factors, such as changes in brain tissue mechanical properties [1, 3, 4] or transmantle pressure gradients [5–7], though the pathophysiology of the disorder remains unknown. We previously reported on a case of a 19-year-old female with LPH who exhibited extremely low brain tissue stiffness when examined with magnetic resonance elastography (MRE) [8], which supports the theory of altered tissue mechanics playing a role in LPH. However, it remained unknown whether the low brain stiffness caused LPH and whether it was reversible. Here, we present a follow-up MRE measurement on the same patient 2 years later.
* Curtis L Johnson [email protected] 1
Carle Neuroscience Institute, Carle Foundation Hospital, Urbana, IL, USA
2
Department of Surgery, University of Illinois College of Medicine, Urbana, IL, USA
3
Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
4
Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
5
Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
Case description A 19-year-old female was admitted to Carle Foundation Hospital in 2015 for shunt malfunction. She previously had a ventriculoperitoneal shunt placed at an outside instituti
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