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. 2023 Aug 23;20(1):63.
doi: 10.1186/s12987-023-00465-w.

A scoping review of the discrepancies in the measurement of cerebral blood flow in idiopathic intracranial hypertension: oligemia, euvolemia or hyperemia?

Grant A Bateman  1   2
Affiliations

A scoping review of the discrepancies in the measurement of cerebral blood flow in idiopathic intracranial hypertension: oligemia, euvolemia or hyperemia?

Grant A Bateman. Fluids Barriers CNS. .

Abstract

Background: The literature regarding the global cerebral blood flow (CBF) in idiopathic intracranial hypertension (IIH) is divergent leading to skepticism about the significance of blood flow to the disease's underlying pathophysiology.

Methods: The purpose of the current paper is to perform a PRISMA scoping review of the literature describing the CBF in IIH. The review investigated the PUBMED and Scopus data bases looking at case mix, technique and the methodologies employed by the studies selected.

Discussion: Many studies indicate that the flow in IIH is normal but others show the flow to be altered. These later studies show a range of flows from a reduction of 20% to an increase of 50% compared to control values. Obesity is a common finding in IIH and is known to reduce CBF, anemia occurs in approximately 20% of IIH patients and is a potent cause of an increased CBF. Thus, variations in case mix may have a significant effect on the final outcome in those studies which are underpowered. The varying techniques which have been used to estimate CBF have differing strengths and weaknesses which may also have a bearing on the outcome. Some papers have significant confounding methodological issues.

Conclusions: This review suggests each of the variables investigated are responsible for the divergent CBF findings in IIH.

Keywords: Anemia; Cerebral blood flow; Idiopathic intracranial hypertension; Obesity; Stenosis.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow chart. A chart showing the numbers of papers included and excluded at each stage
Fig. 2
Fig. 2
Elevated blood flow in a child with IIH. (a) A T1 image of a 6 year old male with IIH who was anemic. Note compression of the pituitary (arrow). (b) A T2 axial image through the orbits showing orbital flattening and dilated optic nerve sheaths. (c) A MR venogram showing no evidence of venous outflow stenosis. (d) A phase contrast flow graph of the arterial inflow at the skull base showing the inflow to be 25.6 mls/s or 1540 ml/min
Fig. 3
Fig. 3
Distribution of patients and controls. A graph showing the distribution of patients in the study by Capel et al. [22], the control patients are consistent with a normal distribution but the IIH patients are skewed to the left with 2 outliers in the higher flow range
See this image and copyright information in PMC

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