A modeling study of idiopathic intracranial hypertension: etiology and diagnosis

Objective: To investigate the relationship between idiopathic intracranial hypertension (IIH) and transverse sinus stenosis through experiments performed on a validated mathematical model. Methods: A mathematical model of intracranial pressure (ICP) dynamics has been extended to accommodate venous s...

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Bibliographic Details
Published in:Neurological research (New York) 2007-12, Vol.29 (8), p.777-786
Main Authors: Stevens, Scott A., Thakore, Nimish J., Lakin, William D., Penar, Paul L., Tranmer, Bruce I.
Format: Article
Language:English
Subjects:
DIFFERENTIAL EQUATIONS
Humans
IDIOPATHIC INTRACRANIAL HYPERTENSION
INTRACRANIAL PRESSURE
LUMPED PARAMETER MODEL
Mathematics
Models, Biological
Pseudotumor Cerebri - cerebrospinal fluid
Pseudotumor Cerebri - diagnosis
Pseudotumor Cerebri - etiology
STEADY STATE
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Summary:Objective: To investigate the relationship between idiopathic intracranial hypertension (IIH) and transverse sinus stenosis through experiments performed on a validated mathematical model. Methods: A mathematical model of intracranial pressure (ICP) dynamics has been extended to accommodate venous sinus compression through the introduction of a Starling-like resistor between the sagittal and transverse sinuses. Results: In the absence of this type of resistor, the sinuses are rigid, and the model has only a unique, stable steady state with normal pressures. With resistance a function of the external pressure on the sinus, a second stable steady state may exist. This state is characterized by elevated ICP concurrent with a compressed transverse sinus. Simulations predict that a temporary perturbation that causes a transient elevation of ICP can induce a permanent transition from the normal to the higher steady state. Comparisons to clinical data from IIH patients provide supporting evidence for the validity of the model's predictions. Simulations suggest a possible clinical diagnostic technique to determine if an individual has a compressible transverse sinus and is at risk for developing IIH. Conclusions: Results of the model experiments suggest that the primary cause of IIH may be a compressible, as opposed to rigid, transverse sinus, and that the observed stenosis is a necessary characteristic of the elevated pressure state.
ISSN:0161-6412
1743-1328
DOI:10.1179/016164107X208112