0:00

Is an 82 year old female that, that came to me with, uh,

0:03

concern for M P H and basically she had progressive gait disturbances, uh, and,

0:08

uh, memory issues. And as you can see, her ventricles are enlarged. Um, and,

0:13

and it is a little bit out of proportion of the degree of her volume loss

0:15

overall. Um,

0:17

you can see she does not have any aqueduct stenosis and her collosal angle is

0:20

narrow, suggesting hydrocephalus rather than just volume loss in this case. Um,

0:24

so we did do a, uh, a flow study, um, and essentially the, the first thing,

0:29

I always look at these axial flow studies.

0:31

I wanna see at least that there's two and fro flow through the aqueduct on the

0:34

initial image acquisition. So I wanna see, um, you know, basically the, the,

0:39

the bright flow jet and then the reverse flow jet giving me sort of a dark

0:43

signal as it as it goes backwards. Um, and essentially you're gonna have, um,

0:47

forward flow and backwards flow.

0:49

The stroke volume is actually the flow in one direction,

0:52

not the flow in both directions. So, um,

0:55

the stroke volume in this patient is around, uh,

0:58

or just a little over a hundred microliters.

1:00

It's very common to see patients have slightly more forward flow than

1:05

backwards flow because they're making C S F, so you presume that, you know,

1:08

they're secreting some out of the brain to go to the arachnoid granulation and

1:12

be reabsorbed. So having a slightly higher forward volume is, is typical,

1:16

but if there's a big discrepancy between forward and backward volume,

1:19

I tend to not really believe the stroke volume. So this is a, a,

1:24

a case where technically the stroke volume was telling us that this patient

1:27

probably had N P H. Um, the flow volume was not that impressive,

1:31

though it was only six mls per minute. Um, whereas, you know,

1:34

24 has been more closely correlated with, with patients who have N P H.

1:39

That being said, you know,

1:40

we felt very strongly about this patient potentially having N P H and we did do,

1:44

uh, high volume LP and this patient recovered dramatically and, and did very,

1:47

very well with a shunt. Um,

1:49

so it just goes to show you the flow study may not always give you the answer.

1:53

Um, it really is meant to mostly predict shunt responsiveness rather than really

1:57

diagnose N P H.