Investigation of the diagnosis value of medium cerebral arterial pulsatility index, resistive index, peak systolic flow velocity and mean flow velocity in patients with clinical suspect of pseudotumor cerebri

Objective: To compare cerebrospinal hypertension measured by lomber puncture with middle cerebral artery pulsatility index, resistive index, peak systolic velocity and mean flow velocity in patients with clinical features of idiopathic intracranial hypertension. Materials and methods: Patients who applied to Akdeniz University Medical Faculty Hospital Neurology Outpatient Clinic with headache and / or papilledema clinic between 2018-2020 were screened. Patients over 18 years of age who underwent LP with a pre-diagnosis of IIH, who did not have a mass, thrombosis or other imaging findings that could explain the clinic in cranial imaging and who underwent transcranial colored doppler (TCCD) on the same day before LP were included in the study. Results: CSF pressure was measured as> 25 in 6 (40%) of 15 patients included in the study. In 3 of these 6 patients, the PI value was found to be above normal (> 1.1), and these patients have the highest intracranial pressure (ICP). No patients with an ICP of less than 25 had a PI> 1.1. When the CSF pressure was accepted as the critical value of 25, when the patients were divided into two groups, it was found that PI and RI were significantly higher in the group with CSF pressure> 25 (p values 0.008 and 0.016, respectively). There was no significant difference in age, BMI, pain intensity, Vmax, Vmean values in the group with CSF pressure> 25 compared to the other group. A positive, high-intensity and statistically significant correlation between CSF pressure and PI (r = 0.779, p <0.01) and a positive, moderate, statistically significant correlation between CSF pressure and RI (r = 0.602, p <0.05) were observed. Discussion: In our study, it was shown that the MCA PI value measured by TCCD was above normal (> 1.1) in 3 of 6 patients with CSF pressure higher than normal. In addition, it was found that there was a statistically positive and significant relationship between CSF pressure and PI and that PI was significantly higher in the patient group with CSF pressure> 25. TCCD is a non-invasive method that requires experience but is practical to apply. These results suggest that in the clinical follow-up of patients with IIH, sequential and serial MCA PI measurements can be used as an adjunct to the evaluation of treatment response. Conclusion: This study suggested that the PI value may be at the lower limit for estimating the increase in ICP in IIH patients and a cut-off value can be determined with a larger number of samples. Keywords: Idiopathic intracranial hypertension, Pseudotumor Cerebri Syndrome, Transcranial Doppler Ultrasound, Pulsatility Index, Resistive Index