Cerebral critical closing pressure in hydrocephalus patients undertaking infusion tests

Objectives: Links between cerebrospinal fluid (CSF) compensation and cerebral blood flow (CBF) have been studied in many clinical scenarios. In hydrocephalus, disturbed CSF circulation seems to be a primary problem, having been linked to CBF disturbances, particularly in white matter close to surfac...

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Bibliographic Details
Published in:Neurological research (New York) 2015-08, Vol.37 (8), p.674-682
Main Authors: Varsos, Georgios V., Czosnyka, Marek, Smielewski, Peter, Garnett, Matthew R., Liu, Xiuyun, Kim, Dong-Joo, Donnelly, Joseph, Adams, Hadie, Pickard, John D., Czosnyka, Zofia
Format: Article
Language:English
Subjects:
Adult
Aged
Biomimetic Materials - administration & dosage
Blood Pressure - physiology
Brain - blood supply
Brain - physiopathology
Cerebrospinal Fluid
Cerebrospinal Fluid Pressure - physiology
Cerebrovascular Circulation - physiology
Critical closing pressure
Female
Humans
Hydrocephalus
Hydrocephalus - diagnosis
Hydrocephalus - diagnostic imaging
Hydrocephalus - physiopathology
Hydrodynamics
Infusion tests
Intracranial pressure
Intracranial Pressure - physiology
Ischemia
Male
Middle Aged
Retrospective Studies
Spinal Puncture - methods
Ultrasonography, Doppler, Transcranial
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Summary:Objectives: Links between cerebrospinal fluid (CSF) compensation and cerebral blood flow (CBF) have been studied in many clinical scenarios. In hydrocephalus, disturbed CSF circulation seems to be a primary problem, having been linked to CBF disturbances, particularly in white matter close to surface of dilated ventricles. We studied possible correlations between cerebral haemodynamic indices using transcranial Doppler (TCD) ultrasonography and CSF compensatory dynamics assessed during infusion tests. Methods: We analysed clinical data from infusion tests performed in 34 patients suspected to suffer from normal pressure hydrocephalus, with signals including intracranial pressure (ICP), arterial blood pressure (ABP) and TCD blood flow velocity (FV). Cerebrospinal fluid compensatory parameters (including elasticity) were calculated according to a hydrodynamic model of the CSF circulation. Critical closing pressure (CrCP) was calculated with the cerebrovascular impedance methodology, while wall tension (WT) was estimated as CrCP-ICP. Closing margin (CM) was expressed as the difference between ABP and CrCP. Results: Intracranial pressure increased during infusion from 6.7 ± 4.6 to 25.0 ± 10.5 mmHg (mean ± SD; P 
ISSN:0161-6412
1743-1328
DOI:10.1179/1743132815Y.0000000044