The Monro-Kellie Doctrine: A Review and Call for Revision

Benson, John C.; Madhavan, Ajay A; Cutsforth‐Gregory, Jeremy K.; Johnson, Derek R.; Carr, Carrie M.

doi:10.3174/ajnr.a7721

Cited by 35 publications

(10 citation statements)

References 34 publications

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“…Even more so, cerebral hemodynamics constitute one of the major driving forces behind cerebrospinal fluid (CSF) movement 13 . As per the Monro–Kellie doctrine, the brain resides in a fixed‐volume chamber, and therefore any change in CBV must be met with an opposing change in brain and/or CSF volume to maintain a constant internal cranial pressure 14,15 . Thus, LF‐CBV change is met with a corresponding LF‐CSF movement.…”

Section: Introductionmentioning

confidence: 99%

“…13 As per the Monro-Kellie doctrine, the brain resides in a fixed-volume chamber, and therefore any change in CBV must be met with an opposing change in brain and/or CSF volume to maintain a constant internal cranial pressure. 14,15 Thus, LF-CBV change is met with a corresponding LF-CSF movement. Because of the recent discovery of the glymphatic system in neurofluid movement and the CSF's role in brain waste clearance, [16][17][18] the importance of understanding CSF dynamics has drastically increased.…”

mentioning

confidence: 99%

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Effects of clamping end‐tidal CO₂ on neurofluidic low‐frequency oscillations

Kish,

Chen,

Tong

2023

NMR in Biomedicine

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In recent years, low‐frequency oscillations (LFOs) (0.01–0.1 Hz) have been a subject of interest in resting‐state functional magnetic resonance imaging research. They are believed to have many possible driving mechanisms, from both regional and global sources. Internal fluctuations in the partial pressure of CO2 (PCO2) has long been thought of as one of these major driving forces, but its exact contributions compared with other mechanisms have yet to be fully understood. This study examined the effects of end‐tidal PCO2 (PetCO2) oscillations on LF cerebral hemodynamics and cerebrospinal fluid (CSF) dynamics under “clamped PetCO2” and “free‐breathing” conditions. Under clamped PetCO2, a participant's PetCO2 levels were fixed to their baseline average, whereas PetCO2 was not controlled in free breathing. Under clamped PetCO2, the fractional amplitude of hemodynamic LFOs in the occipital and sensorimotor cortex and temporal lobes were found to be significantly reduced. Additionally, the fractional amplitude of CSF LFOs, measured at the fourth ventricle, was found to be reduced by almost one‐half. However, the spatiotemporal distributions of blood and CSF delay times, as measured by cross‐correlation in the LF domain, were not significantly altered between conditions. This study demonstrates that, while PCO2 oscillations significantly mediate LFOs, especially those observed in the CSF, other mechanisms are able to maintain LFOs, with high correlation, even in their absence.

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Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Effects of clamping end‐tidal CO₂ on neurofluidic low‐frequency oscillations

Kish,

Chen,

Tong

2023

NMR in Biomedicine

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“…Typically, the thickening occurs along the inner table, more so involving the frontal bone, giving rise to an appearance of layer cake skull. 20 Uncommon Findings in SICH 21 • Ischemia is secondary to brain herniation.…”

Section: Chronic Sichmentioning

confidence: 99%

Spontaneous Intracranial Hypotension: A Review of Neuroimaging and Current Concepts

Goddu Govindappa,

Adiga,

Kumar

et al. 2023

Indian J Radiol Imaging

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Spontaneous intracranial hypotension (SICH) is the emerging cause of orthostatic headache as it has been better recognized in recent years. SICH happens due to spinal cerebrospinal fluid (CSF) leak; however, the manifestations are predominantly cranial and hence imaging in SICH includes brain and spine. There are few characteristic brain imaging features to be concerned about to diagnose SICH in patients with vague symptoms or low clinical suspicion. Spine screening is recommended in these patients to assess spinal CSF leaks. While neuroradiologists play a significant role from the time of diagnosis to treatment of SICH, there is a need for all the general radiologists to be aware of the condition. Computed tomography myelogram and digital subtraction myelogram are performed for diagnostic and therapeutic management of SICH. There is a known risk for SICH recurrence in patients with sagittal longitudinal epidural collection and hence, targeted blood patch should be used instead of blind patch. Most importantly, slow mobilization is recommended following the patch to avoid recurrence.

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“…It was originally based on the work of Alexander Monroe, a Scottish doctor, and his student, George Kellie de Leith 6 . Later, Harvey Cushing formulated this work as Monro-Kellie doctrine 7 .Kalisvaart et al wrote interesting analysis about this doctrine in relation to the tissue compliance 8 .…”

Section: Introductionmentioning

confidence: 99%

Validation of Monro-Kellie doctrine during blood pressure lowering in mice using fNIRS

Ferdinando,

Jukkola,

Moradi

et al. 2024

Dynamics and Fluctuations in Biomedical Photonics XXI

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The Monro-Kellie doctrine states that the sum of the contents of the intracranial cavity is constant, and consequently dynamics of blood and cerebrospinal fluid (CSF) volumes should be in an anti-correlation relationship. This phenomenon helped to explain many abnormalities in intracranial hypotension and CSF depletion. We aimed to validate the same phenomenon in mice during a blood pressure (BP) lowering test. Eight 2-3-month-old C57/Bl6N (Charles River) female mice were used in this study. We used both nicardipine hydrochloride and sodium nitroprusside (SNP) infusion into the femoral vein to lower the BP. A multi-wavelength NIRS (685, 830, and 980 nm) measuring hemoglobin and water concentrations, sampled at 800 Hz, was used. The fiber probes for the light source and detector were inserted into the ear canals and positioned towards the brain, giving a distance of approximately 1 cm. Following the Monro-Kellie doctrine, the blood volume, i.e., total hemoglobin (HbT), and CSF volume should be in an anti-correlation relationship. Our experiments showed that concentration changes of total hemoglobin (HbT) and water, are in anti-correlation with correlation coefficients of -0.991 ± 0.007.

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The Monro-Kellie Doctrine: A Review and Call for Revision

Cited by 35 publications

References 34 publications

Effects of clamping end‐tidal CO₂ on neurofluidic low‐frequency oscillations

Effects of clamping end‐tidal CO₂ on neurofluidic low‐frequency oscillations

Spontaneous Intracranial Hypotension: A Review of Neuroimaging and Current Concepts

Validation of Monro-Kellie doctrine during blood pressure lowering in mice using fNIRS

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The Monro-Kellie Doctrine: A Review and Call for Revision

Cited by 35 publications

References 34 publications

Effects of clamping end‐tidal CO2 on neurofluidic low‐frequency oscillations

Effects of clamping end‐tidal CO2 on neurofluidic low‐frequency oscillations

Spontaneous Intracranial Hypotension: A Review of Neuroimaging and Current Concepts

Validation of Monro-Kellie doctrine during blood pressure lowering in mice using fNIRS

Contact Info

Product

Resources

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Effects of clamping end‐tidal CO₂ on neurofluidic low‐frequency oscillations

Effects of clamping end‐tidal CO₂ on neurofluidic low‐frequency oscillations