Cerebrospinal compensation in hydrocephalic children

Czosnyka, Marek; Batorski, L.; Roszkowski, Marcin; Tomaszewski, J; Wocjan, J; Walencik, A.; Zabołotny, W.

doi:10.1007/bf00301929

Cited by 28 publications

(13 citation statements)

References 22 publications

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“…We feel that further exploitation of this model should have utility in understanding not only those questions but also the complexities of the metabolic response to in creased ICP [41], the effects of compensatory mecha nisms [43], the impact on neuronal migration and matu ration [44] and general development of the compromised brain [45],…”

Section: Discussionmentioning

confidence: 99%

Metabolic Responses of the Neonatal Rabbit Brain to Hydrocephalus and Shunting

Wehby-Grant¹,

Olmstead²,

Peacock³

et al. 1996

Pediatr Neurosurg

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The metabolic changes that occur in the neonatal brain as a result of hydrocephalus, and the response to ventriculoperitoneal shunting, vary with the maturational stage of the brain. In this study, local glucose utilization (LCMRglu) and oxidative metabolic capacity were estimated using 2-deoxyglucose autoradiography and cytochrome oxidase histochemistry, respectively. Hydrocephalus was induced in rabbit pups via intracisternal kaolin injections at 4-6 days of age. Shunting occurred at 19–26 days of age and the animals were sacrificed at ages ranging from 33 to 331 days. In normal animals there was a high glucose demand early in life which showed a decrease at about 60 days of age. In rabbits sacrificed prior to 60 days of age the controls showed the highest LCMRglu with significant decreases in both the hydrocephalic and shunted animals. After 60 days of age the shunted animals had higher LCMRglu than both the hydrocephalic and control subjects. Oxidative metabolic capacity peaked before 50 days of age in normal animals. At the youngest age, both the hydrocephalic and shunted animals showed higher cytochrome oxidase density rates than the control rabbits. In the older group, the hydrocephalic animals remained high while the shunted animals approximated the control densities. Neither the changes seen in the LCMRglu nor the oxidative metabolic capacity were correlated with changes in cell packing density or increased intracranial pressure. These data suggest that when the brain is compromised by hydrocephalus, there is an initial compensatory increase in oxidative metabolic capacity. The development of the glycolytic pathway appears to be retarded by hydrocephalus, but with shunting and the passage of time, the LCMRglu rebounds to levels above that of controls.

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Section: Discussionmentioning

confidence: 99%

Metabolic Responses of the Neonatal Rabbit Brain to Hydrocephalus and Shunting

Wehby-Grant¹,

Olmstead²,

Peacock³

et al. 1996

Pediatr Neurosurg

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“…More than 30 minutes is needed for extra-or intracellular brain tissue change [24]. Pulsatile CSF flow through the foramen magnum to the more compliant lumbar subarachnoid space may provide a certain degree of compensatory reserve but the obstructed flow through this pathway in patients suffering from non-communicating hydrocephalus or in head injuries with compressed ventricles may alter the gradient but does not change the linear character of the amplitude-pressure relationship [10]. Therefore, the rapid, pulse-related inflow of the arterial blood can be compensated for by an equivalent outflow of the venous blood [2].…”

Section: Introductionmentioning

confidence: 98%

“…Can each pulsatile increase in cerebral blood volume be compensated for by reciprocal changes in CSF volume or brain tissue? The mean time needed to accomplish any pressure-volume process, as for example to provoke a stable increase in ICP by constant infusion of saline into a CSF container, ranges several minutes [10]. More than 30 minutes is needed for extra-or intracellular brain tissue change [24].…”

Section: Introductionmentioning

confidence: 99%

Significance of intracranial pressure waveform analysis after head injury

et al. 1996

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The authors have investigated the relationships between the amplitude of the ICP pulse wave, the mean values of ICP and CPP, and the outcome of 56 head injured ventilated patients. The ICP was monitored continuously using a Camino transducer (35 patients) or subdural catheter (21 patients). The mean Glasgow Coma Score was 6 (range 3-13; 5 patients had a GCS > 8 after resuscitation). Patients were grouped according to their Glasgow Outcome Score assessed at 12 months after injury. The amplitude of ICP pulse waveform was assessed using the fundamental harmonic of the pulse waveform (AMP) to avoid distortion caused by different frequency responses of the pressure transducers used in the study. Statistical analysis revealed that in patients with fatal outcome the ICP pulse amplitude increased when the mean ICP increased to 25 mmHg and then began to decrease. The upper breakpoint of the AMP-ICP relationship was not present in patients with good/moderate outcome. The moving correlation coefficient between the fundamental harmonic of ICP pulse wave and the mean ICP (RAP: R-symbol of correlation between A-amplitude and P-pressure) was introduced to describe the time-dependent changes in correlation between amplitude and mean ICP. The RAP was significantly lower in patients who died or remained in the vegetative state. In 7 patients who died from uncontrollable intracranial hypertension RAP was oscillating or decreased to 0 or negative values well before brain-stem herniation. The combination of an ICP above 20 mmHg for a period longer than 6 hours with low correlation between the amplitude and pressure (RAP < 0.5) was described as an predictive index of an unfavourable outcome.

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“…The compliance was therefore pressure-independent for pressures below -5 mm Hg, between -5 mmHg and 5 mm Hg, and above 5 mm Hg. The compliance of the model was selected to be lower than the values previously reported in the literature (from 1.83 ml mmHg -1 in normal children to 0.97 ml mmHg -1 in children with acute hydrocephalus [15]). The model was designed to mimic the 'worst case', i.e.…”

Section: Methodsmentioning

confidence: 99%