The historic evolution of intracranial pressure and cerebrospinal fluid pulse pressure concepts: Two centuries of challenges

Rabelo, Ní­collas Nunes; Brito, Josué da Silva; Silva, Jassiara Soares da; Souza, Nicolli Bellotti de; Coelho, Giselle; Brasil, Sérgio; Frigieri, Gustavo

doi:10.25259/sni_53_2021

Cited by 15 publications

(9 citation statements)

References 28 publications

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“…[16] and Lang tt et al [23], by means of invasive ICP measurement, observed the relation between intracranial volume and ICP variations [24], whereas Nucci et al [20] con rmed that changes in ICPW followed ICP variations; in particular, elevation of the second ICP peak was related to impaired ICC, although quantitative relations between ICPW peaks were not demonstrated in that study. Kazimierska et al [25] performed intracranial elastance assessment by means of infusion test in normal pressure hydrocephalus patients and compared three techniques, including changes in P1 and P2 amplitudes, indicating that the ratio obtained from these peaks has good correlation with the intracranial volumetric manipulation.…”

Section: Discussionmentioning

confidence: 82%

Noninvasive intracranial pressure waveforms for estimation of intracranial hypertension and outcome prediction in acute brain-injured patients

Brasil

Frigieri

Taccone

et al. 2022

J Clin Monit Comput

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Analysis of intracranial pressure waveforms (ICPW) provides information on intracranial compliance. We aimed to assess the correlation between noninvasive ICPW (NICPW) and invasively measured intracranial pressure (ICP) and to assess the NICPW prognostic value in this population. In this cohort, acute brain-injured (ABI) patients were included within 5 days from admission in six Intensive Care Units. Mean ICP (mICP) values and the P2/P1 ratio derived from NICPW were analyzed and correlated with outcome, which was defined as: (a) early death (ED); survivors on spontaneous breathing (SB) or survivors on mechanical ventilation (MV) at 7 days from inclusion. Intracranial hypertension (IHT) was defined by ICP > 20 mmHg. A total of 72 patients were included (mean age 39, 68% TBI). mICP and P2/P1 values were significantly correlated (r = 0.49, p < 0.001). P2/P1 ratio was significantly higher in patients with IHT and had an area under the receiving operator curve (AUROC) to predict IHT of 0.88 (95% CI 0.78–0.98). mICP and P2/P1 ratio was also significantly higher for ED group (n = 10) than the other groups. The AUROC of P2/P1 to predict ED was 0.71 [95% CI 0.53–0.87], and the threshold P2/P1 > 1.2 showed a sensitivity of 60% [95% CI 31–83%] and a specificity of 69% [95% CI 57–79%]. Similar results were observed when decompressive craniectomy patients were excluded. In this study, P2/P1 derived from noninvasive ICPW assessment was well correlated with IHT. This information seems to be as associated with ABI patients outcomes as ICP.Trial registration: NCT03144219, Registered 01 May 2017 Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/NCT03144219.

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Section: Discussionmentioning

confidence: 82%

Noninvasive intracranial pressure waveforms for estimation of intracranial hypertension and outcome prediction in acute brain-injured patients

Brasil

Frigieri

Taccone

et al. 2022

J Clin Monit Comput

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“…2 ) which significantly damped the amplitude of the cardiac CSF pulsations (Fig. 2 A,C) as it does in humans 31 . With the alligator in the head-down position, a slight shift in the peritoneal viscera would have raised intrathoracic pressure, which, when combined with the increase in central venous pressure, would have damped the ventilatory pulsations 32 .…”

Section: Discussionmentioning

confidence: 68%

The influence of spinal venous blood pressure on cerebrospinal fluid pressure

Taylor,

English,

Cramberg

et al. 2023

Sci Rep

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In Alligator mississippiensis the spinal dura is surrounded by a venous sinus; pressure waves can propagate in the spinal venous blood, and these spinal venous pressures can be transmitted to the spinal cerebrospinal fluid (CSF). This study was designed to explore pressure transfer between the spinal venous blood and the spinal CSF. At rest the cardiac-related CSF pulsations are attenuated and delayed, while the ventilatory-related pulsations are amplified as they move from the spinal venous blood to the spinal CSF. Orthostatic gradients resulted in significant alterations of both cardiac- and ventilatory-related CSF pulsations. Manual lateral oscillations of the alligator’s tail created pressure waves in the spinal CSF that propagated, with slight attenuation but no delay, to the cranial CSF. Oscillatory pressure pulsations in the spinal CSF and venous blood had little influence on the underlying ventilatory pulsations, though the same oscillatory pulsations reduced the ventilatory- and increased the cardiac-related pulsations in the cranial CSF. In Alligator the spinal venous anatomy creates a more complex pressure relationship between the venous and CSF systems than has been described in humans.

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“…Professor Mascarenhas questioned the validity of the Monro-Kellie doctrine, which stated that the skull is nonexpandable [ 1 , 2 ], despite the fact that even diamonds expand when subjected to pressure. This inquiry drove him to make the first discovery of a linear correlation between cranial microexpansion and changes in ICP [ 3 ].…”

Section: The Historic Narrativementioning

confidence: 99%

A Point-of-Care Noninvasive Technique for Surrogate ICP Waveforms Application in Neurocritical Care

2023

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The historic evolution of intracranial pressure and cerebrospinal fluid pulse pressure concepts: Two centuries of challenges

Cited by 15 publications

References 28 publications

Noninvasive intracranial pressure waveforms for estimation of intracranial hypertension and outcome prediction in acute brain-injured patients

Noninvasive intracranial pressure waveforms for estimation of intracranial hypertension and outcome prediction in acute brain-injured patients

The influence of spinal venous blood pressure on cerebrospinal fluid pressure

A Point-of-Care Noninvasive Technique for Surrogate ICP Waveforms Application in Neurocritical Care

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