Brainstem evoked potentials and magnetic resonance imaging abnormalities in differential diagnosis of intracranial hypotension - 15/05/19

Doi : 10.1016/j.neucli.2019.04.003

Vincenzo Di Stefano ^a,^b,^⁎ , Camilla Ferrante ^a,^b, Roberta Telese ^a,^b, Massimo Caulo ^a,^c, Laura Bonanni ^a,^b, Marco Onofrj ^a,^b, Raffaella Franciotti ^a,^c
^a Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University, Chieti, Italy
^b Aging Research Centre, Ce.S.I., “G. d’Annunzio” University, Chieti, Italy
^c Institute for Advanced Biomedical Technologies (ITAB), “G. d’Annunzio” University, Chieti, Italy

^⁎Corresponding author at: Department of Neuroscience, Imaging and Clinical Science, “G. d’Annunzio” University, Via Luigi Polacchi, 66013 Chieti, Italy.Department of Neuroscience, Imaging and Clinical Science, “G. d’Annunzio” UniversityVia Luigi PolacchiChieti66013Italy

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Wednesday 15 May 2019
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Summary

Objective

To compare brainstem acoustic evoked potentials (BAEP) and magnetic resonance imaging (MRI) in the differential diagnosis of intracranial hypotension (IH), Chiari malformation (CM) and sensorineural hearing loss (SNHL).

Methods

BAEP were recorded in 18 IH, 18 CM, 20 SNHL patients and 52 controls. MRI were acquired in all IH and CM patients.

Results

Abnormal BAEP were observed in 94% of IH patients, in 33% of CM and 70% of SNHL patients. After recovery from IH, BAEP abnormalities disappeared. Internal auditory canal (IAC) MRI abnormalities were described in 88% of IH patients. MRI signs of IH were observed in 33–78% in IH patients, but the most frequent MRI sign was 8th nerve T2 hyperintensity, with contrast enhancement in T1 sequences. This finding, combined with wave I latency, yielded highest specificity and sensitivity for IH diagnosis.

Conclusions

Our study points out how IH can be effectively distinguished from CM and SNHL through the contribution of neurophysiology and MRI; in particular, evaluation of the 8th nerve achieves a high sensitivity and specificity in patients with IH. Further studies are required to examine the combined use of BAEP recordings ad MRI in diagnosis and monitoring of patients affected by IH.

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Keywords : Brainstem acoustic evoked potential, Chiari malformation, Intracranial hypotension, Magnetic resonance imaging, Sensorineural hearing loss