Regional Cerebral Blood Volume During Acute Transient Rises of the Intracranial Pressure (Plateau Waves)

Pseudotumor Cerebri (Benign Intracranial Hypertension): Etiopathogenesis, Diagnosis, And Management

“…62,63 The argument of Dilauro et al 61 is further supported by observations in humans of an increase in the blood volume on the venous side of the cerebral circulation in pseudotumor cerebri. 36,[54][55][56] Furthermore, the increased intercellular and intracellular brain water content mentioned above also fits with this argument. 56,57 The frequent fluctuation of intracranial pressure at intracranial monitoring has not been studied in detail but may be explained on the basis of frequent physiologic changes in cerebral blood volume.…”

“…Four important observations need to be explained before accepting the above mechanism as the sole factor responsible for the increased intracranial pressure in pseudotumor cerebri. These are (1) the small or normal size of the lateral ventricles [49][50][51][52] and return of the ventricle to normal size after resolution of symptoms 53 ; (2) the increased cerebral blood volume with normal flow, with an intact arteriolar reflex sensitivity to CO 2 inhalation or hypoxia, suggesting the site of the increased volume to be in the cortical veins 36,[54][55][56] ; (3) evidence of brain edema at histologic examination, 57 hemodynamic studies, 56 and at surgery 37 ; and (4) frequent minute-to-minute fluctuations of CSF pressure and return to the original high level within 1 to 2 hours after therapeutic lumbar puncture. 16,58,59 Why don't the lateral ventricles dilate if the subarachnoid CSF volume is increased in pseudotumor cerebri?…”

Successful treatment of post-shunt craniocerebral disproportion by coupling gradual external cranial vault distraction with continuous intracranial pressure monitoring

“…The episodes terminate in an equally abrupt and sharp fall in the ICP to normal levels. 18,19 Studies have shown that plateau waves represent a failure of mechanisms compensating intracranial volume and pressure variations. 18,19 Based on the ICP findings, the patient is triaged into 1 of 3 pathways: if the monitor displays abnormally low pressures, the patient is usually offered a shunt revision in which a gravity-activated valve is placed.…”

“…The episodes terminate in an equally abrupt and sharp fall in the ICP to normal levels. 18,19 Studies have shown that plateau waves represent a failure of mechanisms compensating intracranial volume and pressure variations. …”

Plateau waves: changes of cerebrovascular pressure transmission

“…After a sustained period of elevation, termination of the wave is characterized by a rapid decrease of ICP. Changes of cerebral blood volume are thought to produce corresponding changes of ICP [6]. The onset of the wave has been described by the vasodilatory cascade model, a closed loop unstable process linking active vasodilation, increased cerebral blood volume (CBV), elevated ICP and decreased cerebral perfusion pressure (CPP) [7,8].…”