The relationship of blood flow velocity fluctuations to intracranial pressure B waves

Newell, David W.; Aaslid, Rune; Stooss, Renate; Reulen, H. J.

doi:10.3171/jns.1992.76.3.0415

Cited by 140 publications

(88 citation statements)

References 18 publications

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“…The frequency of the cycles are similar to those of Lundberg B waves (0.5-2 cycles/min) and of similar magnitude and frequency of fluctuations in CBFV seen in preterm babies (8,9), normal adults, and head-injured patients (10,11). Slow periodic cycling is superimposed on the regular rhythm of several other physiological parameters.…”

Section: Discussionsupporting

confidence: 54%

“…Slow regular cycles have been seen in the CBFV of adults and thought to be the origin of a similar phenomenon described by Lundberg in intracranial pressure (Lundberg B waves). In a group of adult head-injured patients slow regular cycles in CBFV were completely synchronous with variations in intracranial pressure monitored invasively (10). The cycles were more prominent in conditions in which there was low intracranial compliance, but could be seen in normal individuals where they were more obvious during sleep (1 1).…”

Section: Icp Intracranial Pressurementioning

confidence: 90%

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The Relationship between Cerebral Blood Flow Velocity Fluctuations and Sleep State in Normal Newborns

et al. 1994

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ABSTRAa. Cerebral blood flow velocity was recorded for an average of 23 4-min epochs during natural sleep in 11 normal full-term newborn babies. Intracranial pressure, core temperature, and respiration were simultaneously and non-invasively monitored. Sleep state was classified using information from EEG, pattern of respiration, and eye and body movements by a trained observer. From a total of 238 epochs, 66 were considered to occur in quiet sleep, 101 in active sleep, and in 77 the baby was awake, in a transitional state or moving excessively. Slow cyclical variations in cerebral blood flow velocity were observed with a frequency of between 2 and 6 cycles/min, and these were of significantly greater amplitude during quiet sleep (24%) com- CBF is linked to metabolic demand, and it is therefore not surprising that total CBF is about 30% lower during quiet sleep when compared with active sleep in adult humans (1). CBF measured with jugular occlusion plethysmography was also lower in quiet sleep in term newborns (2,3). No difference in CBF between sleep states was shown in a group of 15 preterm infants, who have lower CBF than adults and whose cerebral metabolic needs may be less variable between sleep states (4). Using Doppler ultrasound to monitor the velocity of blood flow in the anterior cerebral artery Jorch et al. (5) demonstrated a lower velocity during quiet sleep than active sleep in a group of preterm and term neonates. Doppler ultrasound is unable to quantitate CBF

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Section: Discussionsupporting

confidence: 54%

Section: Icp Intracranial Pressurementioning

confidence: 90%

The Relationship between Cerebral Blood Flow Velocity Fluctuations and Sleep State in Normal Newborns

et al. 1994

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“…Originally, Lundberg (32) proposed that B-waves persisting for a long period probably always could be regarded as a sign of cerebral dysfunction, even though some of the recorded patients had a ICP Ͻ11 mmHg. B-waves have been reported to be frequent in hydrocephalus (3,7,10) but have also been reported in nonhydrocephalic patients with normal ICP (14,34) and in healthy individuals through study of middle cerebral artery oscillations by transcranial Doppler sonography (13,36,38). To our knowledge, this is the first study to report on B-waves measured directly in CSF in healthy young adults, indicating that B-waves should be regarded as a physiological phenomenon.…”

Section: Discussionmentioning

confidence: 87%

Spinal CSF absorption in healthy individuals

Edsbagge

Tisell

Jacobsson

et al. 2004

American Journal of Physiology-Regulatory, Integrative and Comp

143

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The present study examines the extent of spinal cerebrospinal fluid (CSF) absorption in healthy individuals in relation to physical activity, CSF production, intracranial pressure (ICP), and spinal CSF movement. Thirty-four healthy individuals aged 21-35 yr were examined by lumbar puncture and radionuclide cisternography with repeated imaging. ICP was registered before and after CSF drainage, and CSF production was calculated. Spinal CSF absorption was calculated as reduction in spinal radionuclide activity. The radionuclide activity in the spinal subarachnoidal space was gradually decreased by 20 Ϯ 13% (mean Ϯ SD) during 1 h. The reduction was higher in active than in resting individuals (27 Ϯ 12% vs. 13 Ϯ 9%). The mean ICP in 19 of the individuals was 13.6 Ϯ 3.1 cmH 2O. B-waves were found in 79% of the individuals, with a mean frequency of 0.6 Ϯ 0.3 min Ϫ1 . The mean CSF production rate was 0.34 Ϯ 0.13 ml/min. There were no correlations between radionuclide reduction, spinal movement of the radionuclide, and CSF production rate. The spinal radionuclide reduction found in this study indicates a spinal CSF absorption of 0.11-0.23 ml/min, more pronounced in active than in resting individuals. arachnoid villi; cerebrospinal fluid spinal flow; cerebrospinal fluid production; cerebrospinal fluid pressure; radionuclide imaging CEREBROSPINAL FLUID (CSF) is mainly produced in the choroid plexus in the lateral, third, and fourth ventricles, and a minor part is derived from the extracellular space of the brain (37). The CSF flows in a to-and-fro movement with a caudaldirected net flow through the aqueduct of Sylvius and foramina of Luschka and Magendie into the spinal subarachnoidal space (SAS) (39). The pulsative brain movements create a "mixing" of CSF in the fourth ventricle, basal cisterns, and upper spinal SAS (17, 23). Older radionuclide cisternographic (RC) studies have shown that radioactively labeled substances move upward when injected in the lumbar region (11) and downward when injected in the ventricles (12). Within the spinal SAS, a pulsatile to-and-fro flow with a caudal-directed net flow in the ventral and a cranial-directed net flow in the lateral cervical SAS has been reported (25, 42). However, the existence of a CSF bulk flow in any direction within the spinal SAS has been questioned, and RC and MRI observations could be explained by mere diffusion (22). The arachnoid villi in the superior sagittal sinus have generally been thought to be the main site for CSF absorption in humans (2, 40). However, lymphatic drainage pathways have been shown in animal studies to play an important role for CSF clearance (5,27,46). The existence of this pathway in humans remains unclear. Spinal CSF absorption through arachnoid granulations located along the nerve roots, morphologically similar to cranial villi, was suggested by Kido et al. (28), and CSF clearance from the spinal SAS has been demonstrated in sheep and cats (6, 31). The extent and importance of the spinal absorption pathway in humans remain unclear and, to ...

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“…5,12,16,30,32 These biological signals will show frequency peaks within certain frequency bands.6,11 They can be categorized into two groups: 1) the B waves that occur at approximately 0.5-3 cycles per minute, which corresponds to a frequency of 0.008-0.05 Hz;5,16,23 and 2) M waves, which occur at approximately 4-9 cycles per minute, which corresponds to a frequency of 0.07-0.15 Hz. 7,12,22 The 6 ventiabbreviatioNs ABP = arterial blood pressure; CPPopt = optimal cerebral perfusion pressure; GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; ICP = intracranial pressure; IQR = interquartile range; L-PRx = long pressure reactivity index; PVS = persistent vegetative state; TBI = traumatic brain injury.…”

mentioning

confidence: 99%

Short pressure reactivity index versus long pressure reactivity index in the management of traumatic brain injury

Lang

Kasprowicz

Smielewski

et al. 2015

JNS

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A rteriAl blood pressure (ABP), intracranial pressure (ICP), cerebral blood flow velocity measured with transcranial Doppler ultrasonography, and cerebral microcirculation assessed by laser Doppler flow are periodical biological signals that can be continuously monitored and recorded in both routine and ICU settings by using invasive and noninvasive techniques and devices. 5,12,16,30,32 These biological signals will show frequency peaks within certain frequency bands.6,11 They can be categorized into two groups: 1) the B waves that occur at approximately 0.5-3 cycles per minute, which corresponds to a frequency of 0.008-0.05 Hz;5,16,23 and 2) M waves, which occur at approximately 4-9 cycles per minute, which corresponds to a frequency of 0.07-0.15 Hz. 7,12,22 The 6 ventiabbreviatioNs ABP = arterial blood pressure; CPPopt = optimal cerebral perfusion pressure; GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; ICP = intracranial pressure; IQR = interquartile range; L-PRx = long pressure reactivity index; PVS = persistent vegetative state; TBI = traumatic brain injury. obJect The pressure reactivity index (PRx) correlates with outcome after traumatic brain injury (TBI) and is used to calculate optimal cerebral perfusion pressure (CPPopt). The PRx is a correlation coefficient between slow, spontaneous changes (0.003-0.05 Hz) in intracranial pressure (ICP) and arterial blood pressure (ABP). A novel index-the so-called long PRx (L-PRx)-that considers ABP and ICP changes (0.0008-0.008 Hz) was proposed. methods The authors compared PRx and L-PRx for 6-month outcome prediction and CPPopt calculation in 307 patients with TBI. The PRx- and L-PRx-based CPPopt were determined and the predictive power and discriminant abilities were compared. results The PRx and L-PRx correlation was good (R = 0.7, p < 0.00001; Spearman test). The PRx, age, CPP, and Glasgow Coma Scale score but not L-PRx were significant fatal outcome predictors (death and persistent vegetative state). There was a significant difference between the areas under the receiver operating characteristic curves calculated for PRx and L-PRx (0.61 ± 0.04 vs 0.51 ± 0.04; z-statistic = -3.26, p = 0.011), which indicates a better ability by PRx than L-PRx to predict fatal outcome. The CPPopt was higher for L-PRx than for PRx, without a statistical difference (median CPPopt for L-PRx: 76.9 mm Hg, interquartile range [IQR] ± 10.1 mm Hg; median CPPopt for PRx: 74.7 mm Hg, IQR ± 8.2 mm Hg). Death was associated with CPP below CPPopt for PRx (c 2 = 30.6, p < 0.00001), and severe disability was associated with CPP above CPPopt for PRx (c 2 = 7.8, p = 0.005). These relationships were not statistically significant for CPPopt for L-PRx. coNclusioNs The PRx is superior to the L-PRx for TBI outcome prediction. Individual CPPopt for L-PRx and PRx are not statistically different. Deviations between CPP and CPPopt for PRx are relevant for outcome prediction; those between CPP and CPPopt for L-PRx are not. The PRx uses the entire B-wave spectrum for index calculation, whereas the ...

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The relationship of blood flow velocity fluctuations to intracranial pressure B waves

Cited by 140 publications

References 18 publications

The Relationship between Cerebral Blood Flow Velocity Fluctuations and Sleep State in Normal Newborns

The Relationship between Cerebral Blood Flow Velocity Fluctuations and Sleep State in Normal Newborns

Spinal CSF absorption in healthy individuals

Short pressure reactivity index versus long pressure reactivity index in the management of traumatic brain injury

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