Summary
Simultaneous intraventricular and intraspinal pressure recordings in erect patients with obstructive lesions of the CSF pathways reveal differences in pressure which are frequently transitory and produced by pulsation. In nonacute cases without papilloedema but with suspected hindbrain hernia delay in equalization after pressure pulses may be demonstrated, and after Valsalva's manoeuvre differences between the head and the spine may be generated transiently and be responsible for clinical symptomatology. The particular clinical features related to hindbrain hernia are syringomyelia, cough headache, cough syncope, and lower cranial nerve signs with oscillopsia and cerebellar ataxia. Correction of the pressure dissociation is often associated with marked clinical improvement. It is suggested that this form of testing may be of relevance as an indication for operation and also for monitoring the progress of post-operative patients.
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References
Ashton, E., Geddes, R., Fejfar, J., Woven silicone rubber as a venous prosthesis. Brit. med. J.3 (1969), 409–410.
Ayer, J. B., Spinal subarachnoid block as determined by combined cisternal and lumbar puncture with special reference to the early diagnosis of cord tumour. Arch. Neurol. Psychiat. (Chic.)4 (1921), 529–541.
Bannerji, N. K., Millar, J. H. D., Chiari malformation presenting in adult life its relationship to syringomyelia. Brain97 (1974), 157–168.
Barnett, H. J. M., Foster, J. B., Hudgson, P., Syringomyelia. London: Saunders. 1973.
Cameron, A. H., The Arnold-Chiari and other neuro-anatomical malformations associated with spina bifida. J. Path. Bact.73 (1957), 195–211.
Chiari, H., Über Veränderungen des Kleinhirns, des Pons und der Medulla oblongata in Folge von Hydrocephalie des Großhirns. Dtsch. med. Wschr.17 (1891), 1172–1175.
—, Über Veränderungen des Kleinhirns, des Pons und der Medulla oblongata in Folge von congenitaler Hydrocephalie des Großhirns. Denkschrift Akad. Wiss. Wien63 (1896), 71–116.
Dobkin, B. H., Syncope in the adult Chiari malformation. Neurology (Minneap.)28 (1978), 718–720.
Duffy, G. P., Lumbar puncture in the presence of raised intracranial pressure. Brit. med. J.1 (1969), 407–409.
Fremont, F., Hodgson, J. S., Combined ventricular and lumbar puncture in the diagnosis of brain tumour. In: The Human Cerebrospinal Fluid. The Association for Research in Nervous and Mental Disease, Vol. 4, pp. 172–184. New York: Hoeber. 1924.
Hodgson, J. S., Combined ventricular and lumbar puncture in the diagnosis of brain tumour. J. Amer. med. Ass.90 (1928), 1524–1526.
Jefferson, G., The tentorial pressure cone. Arch. Neurol. Psychiat. (Chic.)40 (1938), 857–876.
Kaufmann, G. E., Clarke, K., Continuous simultaneous monitoring of intraventricular and cervical subarachnoid cerebrospinal fluid pressure to indicate development of cerebral or tonsillar herniation. J. Neurosurg.33 (1970), 145–150.
Krayenbühl, H., Evaluation of the different surgical approaches in the treatment of syringomyelia. Clin. Neurol. Neurosurg.77 (1974), 110–128.
Lindegaard, K. G., Skalpe, I. O., Sjaastad, O., Cough syncope: The possible relation to hydrocephalusex vacuo. Europ. Neurol.15 (1977), 340–344.
Lockey, P., Poots, G., Williams, B., Theoretical aspects of the attenuation of pressure pulses within the CSF pathways. Med. biol. Eng.14 (1975), 861–869.
McIntosh, H. O., Estes, E. H., Warren, J. V., The mechanism of cough syncope. American Heart Journal52 (1956), 70–82.
Meyer, A., Herniation of the brain. Arch. Neurol. Psychiat. (Chic.)4 (1920), 387–400.
Morgagni, J. B., The seats and causes of diseases investigated by anatomy. (Translation Alexander, B.) London: Miller, Cadell, Johnson and Payne, 1769.
Rice-Edwards, M., A pathological study of syringomyelia. J, Neurol. Neurosurg. Psychiat.40 (1971), 198–199.
Rooke, E. D., Benign exertional headache. Med. Clin. N. Amer.52 (1968), 801–808.
Saez, R. J., Onofrio, B. M., Yanagihara, T., Experience with Arnold-Chiari malformation 1960–1970. J. Neurosurg.45 (1976), 416–422.
Smyth, G. E., Henderson, W. R., Observations on the cerebrospinal fluid pressure on simultaneous ventricular and lumbar punctures. J. Neurol. Psychiat. (Chic.)1 (1938), 226–237.
Soni, S. R., Intracranial pressure measured by radio telemetry. Thesis. University of Manchester, 1974.
— Continuous measurement of differential CSF pressures across the tentorium. J. Neurol. Neurosurg. Psychiat.37 (1974), 1283–1284.
Symonds, C. P., Cough Headache. Brain79 (1956), 557–568.
Van Houweninge Graftdijk, C. J., Over Hydrocephalus. Thesis, University of Leiden, 1932.
Vincent, C., David, M., Thiebaut, F., Le cône de pression temporal dans les tumeurs des hémisphères cérébraux: Sa Symptomatologie, sa gravité, les traitements qu'il convenient de lui apposer. Rev. Neurol.65 (1936), 536–545.
West, R. J., Williams, B., Radiographic studies of the ventricles in syringomyelia. Neuroradiology20 (1980), 5–16.
Williams, B., Current concepts of syringomyelia. Brit. J. Hosp. Med.4 (1970), 331–342.
— A Demonstration Analogue for Ventricular and Intraspinal Dynamics (DAVID). J. Neurol. Sci.23 (1974), 445–461.
— Cerebrospinal fluid pressure gradients in spina bifida cystica, with special reference to the Arnold-Chiari malformation and aqueductal stenosis. Dev. Med. Child Neurol. Supp.35 (1975), 138–150.
— A critical appraisal of posterior fossa surgery for communicating syringomyelia. Brain101 (1978), 223–250.
— Subarachnoid pouches of the posterior fossa with syringomyelia. Acta neurochir. (Wien)47 (1979), 187–219.
— Cough headache due to craniospinal pressure dissociation. Arch. Neurol. (Chic.)37 (1980), 226–230.
Zierski, J., Personal communication. 1975.
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Williams, B. Simultaneous cerebral and spinal fluid pressure recordings. Acta neurochir 59, 123–142 (1981). https://doi.org/10.1007/BF01411198
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DOI: https://doi.org/10.1007/BF01411198