None listed
Conditions
Brief summary
The recent advent of amplified MRI has resulted in improvements in our ability to rapidly observe and inspect cardiac driven brain motions. aMRI amplifies the microscopic motion that occurs in the brain during a heartbeat. To test this theory, in this preliminary study, we apply aMRI pre- and post-lumbar puncture in IIH to explore whether the brain motion patterns are altered. If such cardiac-linked brain motion can be detected, this has the potential to allow for the non-invasive measurement of ICP. The central hypothesis posits that brain motion will be predictably and proportionally altered by changes in the level of ICP. The underlying rationale is that this motion is strongly determined by brain compliance and its perfusion, which is in turn strongly affected by the overall pressure within the cranium surrounding it (i.e. ICP).
Interventions
Lumbar Puncture: Performed by experienced anesthetist, recording opening and closing pressure with spinal manometry to achieve a closing pressure of 25cmH2O or lower. this is expected to take 30-40 minutes. The lumbar puncture will take place within half an hour of the first MRI scan
MRI: includes both standard and study specific sequences (amplified). This will be conducted twice, both before and 4 hours after the lumbar puncture. The MRI will be administered by an MRI technician and is expect
Lumbar Puncture: Performed by experienced anesthetist, recording opening and closing pressure with spinal manometry to achieve a closing pressure of 25cmH2O or lower. this is expected to take 30-40 minutes. The lumbar puncture will take place within half an hour of the first MRI scan MRI: includes both standard and study specific sequences (amplified). This will be conducted twice, both before and 4 hours after the lumbar puncture. The MRI will be administered by an MRI technician and is expected to take 45 to 60 minutes for each scan. The scan will be reviewed by a radiologist. The sequences will include both standard and study specific sequences. The study sequences are: 1. 2D Phase Contrast MRI for CSF flow in the region of the cerebral aqueduct and C2 of the spine to ascertain flow rates and regurgitation fraction 2. 4D Blood Flow analyzed through tested Quantitative Velocity Tool (QVT ) software (4D flow analysis tool developed by associates of University of Auckland) 3. aMRI data (Balanced Steady-State Free Precession Cine MR Imaging - cine bSSFPC MRI of the brain, amplified to 40x) to qualitatively map and quantitatively determine displacement of the brain over a cardiac cycle, with priority on areas that experience CSF flow and major brain motion, e.g. the ventricles, brainstem and upper spine. OCT Scanning: imaging of the intraocular portion of the optic nerve head will be acquired before and after lumbar puncture. This investigation is expected to take 10-15 minutes and will be administered by either an imaging technician or an ophthalmologist. It will be reviewed by an ophthalmologist. The OCT scan will occur twice, each time prior to the MRI scan.
Sponsors
Matai Medical Research Institute
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Diagnosis
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
16 Years to 55 Years
Healthy volunteers
No
Inclusion criteria
• Adult subject 16 years or older • Suspected or confirmed diagnosis of IIH by consultant ophthalmologist or neurologist. • Subject willing and able to consent. • Documented medical history and required information available for data collection.
Exclusion criteria
• Standard contraindications to MR imaging or to gadolinium-based contrast agents. • History of lumbar spinal pathology or other vertebral pathology.
Outcome results
None listed