Skip to main content
SpringerLink
Log in

Clinical observations on the relationship between cerebrospinal fluid pulse pressure and intracranial pressure

  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Summary

A method is described for monitoring the relationship between CSF pulse pressure and ICP in clinical patients. Highly significant linear relationships were found during 65 continuous ICP recordings in 58 patients. The slope value of this relationship showed a positive correlation with the elastance coefficient, a volume-pressure parameter assessed by bolus injection. However, the correlation was too weak to allow for a confident prediction of the elastance coefficient on the basis of CSF pulse pressure in the individual patient. This was attributed to the variable magnitude of the volume change underlying the CSF pulse pressure: the pulsatile variation in cerebral blood volume. This quantity was calculated on the basis of a mathematical model from the slope value and the elastance coefficient and was found to vary between 0.36 and 4.38ml. During plateau waves a disproportionate increase in pulse pressure with the ICP was observed in contrast with a relative decrease in intracranial elastance. This phenomenon was ascribed to an increase in the pulsatile variation in cerebral blood volume. It is concluded that, under certain conditions, the intracranial volume-pressure relationship can be continuously monitored by means of CSF pulse pressure analysis. The findings during plateau waves suggest that the pulse pressure also reflects the state of the cerebral vasomotor tone.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Avezaat, C. J. J., Eijndhoven, J. H. M. van, Jong, D. A. de, Moolenaar, W. C. J., A new method of monitoring intracranial volume-pressure relationships. In: Intracranial Pressure III (Beks, J. W. F., Bosch, D. A., Brock, M., eds.), pp. 308–313. Berlin-Heidelberg-New York: Springer. 1976.

    Google Scholar 

  2. Avezaat, C. J. J., Eijndhoven, J. H. M. van, Wyper, D. J., Cerebrospinal fluid pulse pressure and intracranial volume-pressure relationships. J. Neurol. Neurosurg. Psychiat.42 (1979), 687–700.

    PubMed  Google Scholar 

  3. Avezaat, C. J. J., Eijndhoven, J. H. M. van, Wyper, D. J., Effects of hypercapnia and arterial hypotension and hypertension on cerebrospinal fluid pulse pressure and intracranial volume-pressure relationships. J. Neurol. Neurosurg. Psychiat.43 (1980), 222–234.

    PubMed  Google Scholar 

  4. Barnes, R. W., McGraw, C. P., A new on-line portable ICP data processor. In: Intracranial Pressure II (Lundberg, N., Pontén, U., Brock, M., eds.), pp. 389–390. Berlin-Heidelberg-New York: Springer. 1975.

    Google Scholar 

  5. Brock, M., Diefenthaler, K., Zywietz, C., Pöll, W., Mock, P., Dietz, H., Amplitude analysis of intracranial pressure recordings. In: Intracranial Pressure II (Lundberg, N., Pontén, U., Brock, M., eds.), p. 391. Berlin-Heidelberg-New York: Springer. 1975.

    Google Scholar 

  6. Brock, M., Zywietz, C., Mock, P., Wiegand, H., Zillig, C., Tamburus, W. M., Reliability and reproduceability of ICP frequence analysis. In: Intracranial Pressure III (Beks, J. W. F., Bosch, D. A., Brock, M., eds.), pp. 288–294. Berlin-Heidelberg-New York: Springer. 1976.

    Google Scholar 

  7. Cohadon, F., Castel, J. P., Nouillant, A., Vandendriessche, M., Volume pressure relationship in clinical and experimental conditions of raised ICP. In: Intracranial Pressure II (Lundberg, N., Pontén, U., Brock, M., eds.), pp. 107–112. Berlin-Heidelberg-New York: Springer. 1975.

    Google Scholar 

  8. Corbin, S. D., Schmidt, E. V., Silverberg, G. D., Fryer, T. B., Data display for intracranial pressure monitoring. In: Intracranial Pressure IV (Shulman, K., Marmarou, A., Miller, J. D., Becker, D. P., Hochwald, G. M., Brock, M., eds.), pp. 426–428. Berlin-Heidelberg-New York: Springer. 1980.

    Google Scholar 

  9. Crockard, H. A., Hanlon, K., Ganz, E., Duda, E. E., Intracranial pressure gradients in a patient with a thalamic tumor. Surg. Neurol.5 (1976), 151–154.

    PubMed  Google Scholar 

  10. Eijndhoven, J. H. M. van, Avezaat, C. J. J., Cerebrospinal fluid pulse pressure and craniospinal dynamics. A theoretical, clinical and experimental study. Thesis, Erasmus University Rotterdam. The Hague: A. Jongbloed en Zoon. 1984.

    Google Scholar 

  11. Eijndhoven, J. H. M. van, Avezaat, C. J. J., An experimental study on the pulsatile variations in cerebral blood volume. In press.

  12. Fridén, H., Ekstedt, J., CSF pressure-volume relation and pulse related CSF pressure variations in man. In: Intracranial Pressure IV (Shulman, K., Marmarou, A., Miller, J. D., Becker, D. P., Hochwald, G. M., Brock, M., eds.), pp. 93–96. Berlin-Heidelberg-New York: Springer. 1980.

    Google Scholar 

  13. Godin, D., Stevenaert, A., Lhommel, R., Study of the CSF pulsation transfer: Application to the frequency analysis. In: Intracranial Pressure IV (Shulman, K., Marmarou, A., Miller, J. D., Becker, D. P., Hochwald, G. M., Brock, M., eds.), pp. 191–194. Berlin-Heidelberg-New York: Springer. 1980.

    Google Scholar 

  14. Graham, S. H., Hackenberry, L. E., Rea, G., Miner, M. E., A microcomputer system for ICP analysis. In: Intracranial Pressure IV (Shulman, K., Marmarou, A., Miller, J. D., Becker, D. P., Hochwald, G. M., Brock, M., eds.), pp. 409–412. Berlin-Heidelberg-New York: Springer. 1980.

    Google Scholar 

  15. Guillaume, J., Janny, P., Manométrie intracrânienne continue. Intérêt de la méthode et premier résultats. Rev. Neurol.84 (1951), 131–142.

    PubMed  Google Scholar 

  16. Guinane, J. E., Cerebrospinal fluid pressure and brain compliance in adult cats. Neurology25 (1975), 559–564.

    PubMed  Google Scholar 

  17. Hartmann, A., Continuous monitoring of CSF pressure in acute subarachnoid hemorrhage. In: Intracranial Pressure IV (Shulman, K., Marmarou, A., Miller, J. D., Becker, D. P., Hochwald, G. M., Brock, eds.), pp. 220–228. Berlin-Heidelberg-New York: Springer. 1980.

    Google Scholar 

  18. Hulme, A., Cooper, R., Multi-channel data acquisition and analysis in clinical practice. In: Intracranial Pressure II (Lundberg, N., Pontén, U., Brock, M., eds.), pp. 387–388. Berlin-Heidelberg-New York: Springer. 1975.

    Google Scholar 

  19. Janny, P., La pression intra-crânienne chez l'homme. Méthode d'enregistrement, étude de ses variations et des rapports avec des signes cliniques et ophtalmologiques. Thèse. Paris: Clermont-Ferrand reproduction. 1950.

    Google Scholar 

  20. Janny, P., La surveillance de la pression intra-crânienne en neurochirurgie. Neurochir.20 (1974), 521–554.

    Google Scholar 

  21. Janny, P., Jouan, J. P., Janny, L., Gourgand, M., Gueit, U. M., A statistical approach to long-term monitoring of intracranial pressure. In: Intracranial Pressure (Brock, M., Dietz, H., eds.), pp. 59–64. Berlin-Heidelberg-New York: Springer. 1972.

    Google Scholar 

  22. Kullberg, G., A method for statistical analysis of intracranial pressure recordings. In: Intracranial Pressure (Brock, M., Dietz, H., eds.), pp. 65–69. Berlin-Heidelberg-New York: Springer. 1972.

    Google Scholar 

  23. Langfitt, T. W., Weinstein, J. D., Kassel, N. F., Cerebral vasomotor paralysis produced by intracranial hypertension. Neurology15 (1965), 622–641.

    PubMed  Google Scholar 

  24. Löfgren, J., Essen, C. von, Zwetnow, N. N., The pressure-volume curve of the cerebrospinal fluid space in dogs. Acta Neurol. Scand.49 (1973), 557–574.

    PubMed  Google Scholar 

  25. Lundberg, N., Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiat. Neurol. Scand.36, Suppl. 149 (1960).

  26. Lundberg, N., Cronqvist, S., Kjällquist, A., Clinical investigations of interrelations between intracranial pressure and intracranial hemodynamics. Progr. Brain Res.30 (1968), 69–75.

    Google Scholar 

  27. Marmarou, A., Shulman, K., La Morgese, J., Compartmental analysis of compliance and outflow resistance of the cerebrospinal fluid system. J. Neurosurg.43 (1975), 523–534.

    PubMed  Google Scholar 

  28. Mason, J., Price, D. J., Trimnell, S., The integration of ICP with other monitoring signals on a single computer data base. In: Intracranial Pressure IV (Shulman, K., Marmarou, A., Miller, J. D., Becker, D. P., Hochwald, G. M., Brock, M., eds.), pp. 429–431. Berlin-Heidelberg-New York: Springer. 1980.

    Google Scholar 

  29. Miller, J. D., Volume and pressure in the craniospinal axis. Clin. Neurosurg.22 (1975), 76–105.

    PubMed  Google Scholar 

  30. Miller, J. D., Garibi, J., Intracranial volume-pressure relationship during continuous monitoring of ventricular fluid pressure. In: Intracranial Pressure (Brock, M., Dietz, H., eds.), pp. 270–274. Berlin-Heidelberg-New York: Springer. 1972.

    Google Scholar 

  31. Miller, J. D., Garibi, J., Pickard, J. D., Induced changes of cerebrospinal fluid volume. Arch. Neurol.28 (1973), 265–269.

    PubMed  Google Scholar 

  32. Miller, J. D., Leech, P. J., Assessing the effects of mannitol and steroid therapy on intracranial volume-pressure relationships. J. Neurosurg.42 (1975), 274–281.

    PubMed  Google Scholar 

  33. Rickham, P. P., Penn, I. A., The place of the ventriculostomy reservoir in the treatment of myelomeningoceles and hydrocephalus. Develop. Med. Child Neurol.7 (1965), 296–301.

    Google Scholar 

  34. Risberg, J., Lundberg, N., Ingvar, D. H., Regional cerebral blood volume during acute transient rises of the intracranial pressure (plateau waves). J. Neurosurg.31 (1969), 303–310.

    PubMed  Google Scholar 

  35. Shapiro, K., Marmarou, A., Shulman, K., Characterization of clinical CSF dynamics and neural axis compliance using the pressure-volume index. I. The normal pressure-volume index. Ann. Neurol.7 (1980), 508–514.

    PubMed  Google Scholar 

  36. Shulman, K., Marmarou, A., Pressure-volume considerations in infantile hydrocephalus. Develop. Med. Child Neurol.13, Suppl. 25 (1971), 90–95.

    Google Scholar 

  37. Sklar, F. H., Beyer, C. W., Hagler, H., Ramanathan, M., Clark, W. K., The pressure-volume function of brain elasticity and its relationship with ventricular size. In: Intracranial Pressure IV (Shulman, K., Marmarou, A., Miller, J. D., Becker, D. P., Hochwald, G. M., Brock, M., eds.), pp. 81–84. Berlin-Heidelberg-New York: Springer. 1980.

    Google Scholar 

  38. Stålhammer, D., Arkelsjö, P., Lindström, L., Örtengren, R., Intracranial pressure registration administrated by a microprocessor. In: Intracranial Pressure IV (Shulman, K., Marmarou, A., Miller, J. D., Becker, D. P., Hochwald, G. M., Brock, M., eds.), pp. 404–408. Berlin-Heidelberg-New York: Springer. 1980.

    Google Scholar 

  39. Szewczykowkski, J., Sliwka, S., Kunicki, A., Dytko, P., Korsak-Sliwka, J., A fast method of estimating the elastance of the intracranial system. A practical application in neurosurgery. J. Neurosurg.47 (1977), 19–26.

    PubMed  Google Scholar 

  40. Takizawa, H., Chishiki, T., Muraoka, K., Sugiura, K., A combination of bed-side ICP recordings; histogram, trend-graph and digital print. In: Intracranial Pressure IV (Shulman, K., Marmarou, A., Miller, J. D., Becker, D. P., Hochwald, G. M., Brock, M., eds.), pp. 400–403. Berlin-Heidelberg-New York: Springer. 1980.

    Google Scholar 

  41. Turner, J. M., McDowall, D. G., Gibson, R. M., Khalili, H., Computer analysis of intracranial pressure measurements: Clinical value and nursing response. In: Intracranial Pressure III (Beks, J. W. F., Bosch, D. A., Brock, M., eds.), pp. 283–287. Berlin-Heidelberg-New York: Springer. 1976.

    Google Scholar 

  42. Wilkinson, H. A., Schuman, N., Ruggiero, J., Nonvolumetric methods of detecting impaired intracranial compliance or reactivity. Pulse width and wave from analysis. J. Neurosurg.50 (1979), 758–767.

    PubMed  Google Scholar 

Download references

Author information

Author notes

  1. C. J. J. Avezaat

    Present address: Department of Neurosurgery, Academic Hospital Rotterdam, The Netherlands

  2. J. H. M. van Eijndhoven

    Present address: Department of Electro-Neurology, Erasmus University, Rotterdam, The Netherlands

Authors and Affiliations

  1. Department of Neurosurgery, Academic Hospital Rotterdam, The Netherlands

    J. H. M. van Eijndhoven

  2. Department of Electro-Neurology, Erasmus University, Rotterdam, The Netherlands

    C. J. J. Avezaat

Authors
  1. C. J. J. Avezaat
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. H. M. van Eijndhoven
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Avezaat, C.J.J., van Eijndhoven, J.H.M. Clinical observations on the relationship between cerebrospinal fluid pulse pressure and intracranial pressure. Acta neurochir 79, 13–29 (1986). https://doi.org/10.1007/BF01403461

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01403461

Keywords

Search

Navigation