Elective ICP monitoring: how long is long enough?

Thompson, Simon D; Coutts, Alison; Craven, Claudia; Toma, Ahmed K; Thorne, Lewis; Watkins, Laurence

doi:10.1007/s00701-016-3074-z

Cited by 14 publications

(20 citation statements)

References 15 publications

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“…Majority of the studies were done in the end of twentieth century as well as in the end of the previous decade. Cohorts were mainly rather small (range 6–116 IIH patients) [ 5 , 8 , 9 , 14 – 16 , 19 – 21 , 23 , 24 , 27 , 29 , 30 , 39 , 42 , 48 , 51 ]. Most of the studies were case series, case-control studies and retrospective cohorts [ 5 , 8 , 9 , 14 – 16 , 19 , 20 , 23 , 24 , 27 , 29 , 38 , 42 , 48 ].…”

Section: Resultsmentioning

confidence: 99%

“…Cohorts were mainly rather small (range 6–116 IIH patients) [ 5 , 8 , 9 , 14 – 16 , 19 – 21 , 23 , 24 , 27 , 29 , 30 , 39 , 42 , 48 , 51 ]. Most of the studies were case series, case-control studies and retrospective cohorts [ 5 , 8 , 9 , 14 – 16 , 19 , 20 , 23 , 24 , 27 , 29 , 38 , 42 , 48 ]. Three of the studies were prospective [ 29 , 30 , 51 ].…”

Section: Resultsmentioning

confidence: 99%

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Cerebrospinal fluid dynamics in idiopathic intracranial hypertension: a literature review and validation of contemporary findings

et al. 2021

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Background Idiopathic intracranial hypertension (IIH) is a rare disease of unknown aetiology related possibly to disturbed cerebrospinal fluid (CSF) dynamics and characterised by elevated intracranial pressure (ICP) causing optic nerve atrophy if not timely treated. We studied CSF dynamics of the IIH patients based on the available literature and our well-defined cohort. Method A literature review was performed from PubMed between 1980 and 2020 in compliance with the PRISMA guideline. Our study includes 59 patients with clinical, demographical, neuro-ophthalmological, radiological, outcome data, and lumbar CSF pressure measurements for suspicion of IIH; 39 patients had verified IIH while 20 patients did not according to Friedman’s criteria, hence referred to as symptomatic controls. Results The literature review yielded 19 suitable studies; 452 IIH patients and 264 controls had undergone intraventricular or lumbar CSF pressure measurements. In our study, the mean CSF pressure, pulse amplitudes, power of respiratory waves (RESP), and the pressure constant (P0) were higher in IIH than symptomatic controls (p < 0.01). The mean CSF pressure was higher in IIH patients with psychiatric comorbidity than without (p < 0.05). In IIH patients without acetazolamide treatment, the RAP index and power of slow waves were also higher (p < 0.05). IIH patients with excess CSF around the optic nerves had lower relative pulse pressure coefficient (RPPC) and RESP than those without (p < 0.05). Conclusions Our literature review revealed increased CSF pressure, resistance to CSF outflow and sagittal sinus pressure (SSP) as key findings in IIH. Our study confirmed significantly higher lumbar CSF pressure and increased CSF pressure waves and RAP index in IIH when excluding patients with acetazolamide treatment. In overall, the findings reflect decreased craniospinal compliance and potentially depleted cerebral autoregulation resulting from the increased CSF pressure in IIH. The increased slow waves in patients without acetazolamide may indicate issues in autoregulation, while increased P0 could reflect the increased SSP.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Cerebrospinal fluid dynamics in idiopathic intracranial hypertension: a literature review and validation of contemporary findings

et al. 2021

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“…While we would expect older shunts to present such intraluminal debris, a significant association between shunt age and paradoxical effect was not found in this study. Previous experience suggests that, if there are no in-between interventions, different sets of elective 24-h ICP monitoring measured in the same patient do not significantly differ [ 14 ]. However, the possibility that random ICP changes may have affected the before and/or after valve adjustment ICP results generating a paradoxical ICP response exists.…”

Section: Discussionmentioning

confidence: 99%

“…ICP monitoring admissions were conducted according to an established local protocol [7,14]. Indications for this investigation were discussed in a multidisciplinary context including the opinions of neurosurgeons, neurologists, ophthalmologists and radiologists.…”

Section: Icp Monitoringmentioning

confidence: 99%

Paradoxical response of intracranial pressure to shunt valve setting adjustments

et al. 2020

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Background The hydrodynamics of cerebrospinal fluid shunts have been described in vitro; however, knowledge on the response of intracranial pressure (ICP) to valve settings adjustments in vivo is limited. This study describes the effect of adjusting the shunt valve setting on ICP in a cohort of patients with complex symptom management. Method Single-centre retrospective observational study. Patients who underwent ICP-guided valve setting adjustments during 24-h continuous ICP monitoring, between 2014 and 2019, were included. Patients with suspected shunt malfunction were excluded. Median night ICP before and after the valve adjustments were compared (Δ night ICP). The responses of ICP to valve adjustment were divided into 3 different groups as follows: expected, paradoxical and no response. The frequency of the paradoxical response and its potential predicting factors were investigated. Results Fifty-one patients (37 females, 14 males, mean age 38 years) receiving 94 valve setting adjustments met the study inclusion criteria. Patients’ underlying conditions were most commonly hydrocephalus (47%) or idiopathic intracranial hypertension (43%). The response of ICP to valve setting adjustments was classified as ‘expected’ in 54 cases (57%), ‘paradoxical’ in 17 cases (18%) and ‘no effect’ (Δ night ICP < 1 mmHg) in 23 cases (24%). There was a significant correlation between the Δ night ICP and the magnitude of valve setting change in both the investigated valves (Miethke ProGAV, p = 0.01 and Medtronic Strata, p = 0.02). Conclusions Paradoxical ICP changes can occur after shunt valve setting adjustments. This observation should be taken into account when performing ICP-guided valve adjustments and is highly relevant for the future development of “smart” shunt systems.

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“…Therefore, whilst 10 mm Hg may be the upper-end of pathological, for some patients it was as low as 6 mm Hg. It is known that posture can have a large effect on ICP and therefore also CSFp 19,20. We stress that these values are obtained after 24-hour continuous ICPM, unlike the isolated readings obtained in head injury patients.In 2015, Kattah and colleagues performed a similar study in patients with papilloedema using CSF pressure (CSFp) on lumbar puncture measurements 18.…”

mentioning

confidence: 87%