The Role of Cerebrospinal Fluid Dynamics in Arachnoid Granulations and Brain Herniation: Clinical Significance and Implications

Background: Arachnoid granulations (AGs) are small projections into the brain's venous sinuses, crucial for cerebrospinal uid (CSF) absorption. Brain herniation into arachnoid granulations (BHAGs) is associated with elevated intracranial pressure, particularly idiopathic intracranial hypertension (IIH). This study investigates the prevalence and clinical signicance of AGs and BHAGs purpose: in patients with headaches, vertigo, and pulsatile tinnitus. A retrospective study of 200 patients undergoing MRI from January 2 Methods: 022 to January 2023 assessed T2- weighted imaging (T2WI). Inclusion criteria focused on patients over 18 with unexplained neurological symptoms. AGs were present in Results: 13.6% of patients, with BHAGs observed in 7%. Among BHAG patients, 57% showed features of IIH. Temporal BHAGs were most common, constituting 64.3% of cases. AGs are common ndings, while BHAGs signicantly correlate with IIH. Th Conclusion: eir presence warrants further evaluation for elevated intracranial pressure, emphasizing their importance in clinical practice.