Cerebrospinal Fluid Flow Jet Phenomenon as a Mark of Intracranial Pressure in an Infant with Intraventricular Hemorrhage. Clinical Observation

The phenomenon of cerebrospinal fluid (CSF) flow jet dynamics using color doppler imaging in infants with intraventricular hemorrhages and meningitis was described by Winkler P. in 1991, but it did not attract widespread attention to the medical community and remains obscure for ultrasound diagnostics specialists.

Objective. CSF flow jet as a rare echographic phenomenon in infant with intraventricular hemorrhage dynamics in an infant.

Materials and Methods. A clinical case of the grade III left-sided intraventricular hemorrhage in a premature neonate is presented. Neurosonography data are presented by color-coded and pulse-wave Doppler modes in evaluation of the CSF flow jet phenomenon.

Results. Dynamic echographic observation demonstrated a ventriculomegaly increase with a parallel change in CSF flow from respiratory synchronized to cardio synchronized pattern. On the 31st day of life, 30 minutes after ventriculostomy and implantation of subgaleal drainage, retrieval of the respiratory-synchronized pattern of the CSF flow jet was determined during ultrasound evaluation through relaxation of a major fontanel. The observation was supplemented with archival materials.

Conclusion. The presented clinical observation and archival ultrasound data speculate concerning that the type of synchronizing spontaneous pattern of the CSF flow jet phenomenon have a specific importance for evaluation intracranial hypertension. Certainly, this hypothesis needs further investigation, accumulation of clinical material and its generalization.

1. Vasiliev A. Yu., Olkhova E. B. Ul'trazvukovaja diagnostika v neotlozhnoj detskoj praktike: rukovodstvo dlja vrachej: v dvuh tomah. Tom I. M.: GJeOTAR-Media, 2024. P. 21–80. ISBN 978-5-9704-7043-5. (In Russ.).

2. Cho H., Kim Y., Hong S., Choi H. Cerebrospinal Fluid Flow in Normal Beagle Dogs Analyzed Using Magnetic Resonance Imaging. J. Vet Sci. 2021;22(1):e2. https://doi.org/10.4142/jvs.2021.22. e2

3. Ha J. H., Borzage M. T., Vanstrum E. B., Doyle E. K., Upreti M., Tamrazi B., Nelson M., Blüml S., Johal M. S., Mc-Comb J. G., Chu J., Durham S., Krieger M. D., Moats R. A., Chiarelli P. A. Quantitative Noninvasive Measurement of Cerebrospinal Fluid Low in Shun ted Hydrocephalus. J. Neurosurg. 2023;140 (4):1117-1128. https://doi.org/10.3171/2023.7.JNS231326

4. Hwang M., Tierradentro-García L. O., Kozak B. L., Darge K. Cerebrospinal Fluid Flow Detection in Post-hemorrhagic Hydrocephalus With Novel Microvascular Imaging Modality. J. Ultrasound Med. 2022;41(4):1013-1017. https://doi.org/10.1002/jum.15781

5. Lloyd R. A., Butler J. E., Gandevia S. C., Ball I. K., Toson B., Stoodley M. A., Bilston, L. E. Respiratory Cerebrospinal Fluid Flow is Driven by the Thoracic and Lumbar Spinal Pressures. J. Physiol. 2020; 598(24):5789-5805. https://doi.org/10.1113/JP279458

6. Mathew M., Jimoh A. O., Matthew L. M., Mezue W. C., Uche E. O., Igashi J., Mahmud M. R., Okpara S. E., Mathew M. B. Assessment of Childhood Intracranial Pressure: a Comparative Study of Transcranial Doppler Ultrasound Indices and Findings at Ventriculoperitoneal Shunt. Child's Nerv Syst. 2024; 40(9):2915-2920. https://doi.org/10.1007/s00381-024-06496-4

7. Tatsuno M., Uchida K., Okuyama K., Kawauchi A. Color Doppler Flow Imaging of CSF Flow in an Infant with Intraventricular Hemorrhage. Brain Dev. 1992; 14(2):110-113. https://doi.org/10.1016/s0387-7604(12)80097-0

8. Tierradentro-Garcia L. O., Onyango L., Dennis R., Freeman C. W., Haddad S., Kozak B., Hwang M. Evaluation of the Ce rebrospinal Fluid Flow Dynamics with Microvascular Imaging Ultra sound in Infants. Children (Basel). 2023;10(2): 245. https://doi.org/10.3390/children10020245

9. Winkler P. Colour-coded Echographic Flow Imaging and Spectral Analysis of Cerebrospinal Fluid (CSF) in In fants. Part II. CSF-dynamics. Pediatr Radiol. 1992;22(1):31-42. https://doi.org/10.1007/BF02011606