Body position and cerebrospinal fluid pressure

1976 ◽  
Vol 44 (6) ◽  
pp. 687-697 ◽  
Author(s):  
Bjørn Magnæs
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebral Blood Volume ◽  
Clinical Symptoms ◽  
Body Position ◽  
Fluid Pressure ◽  
Stationary Waves ◽  
Transient Waves ◽  
Content Type ◽  
Csf Pressure ◽  
Arterial Blood

✓ Cerebrospinal fluid (CSF) pressure was recorded in 149 patients and arterial blood pressure (BP) in 11 patients while moving between lateral and sitting positions. Rapid tilting initiated waves in BP and CSF filling pressure. The postural CSF pressure wave manifested itself either as a transient or as a stationary wave similar to a plateau wave. When patients sat up, transient waves had amplitudes up to 550 and stationary waves up to 1000 mm H2O. When they lay down, transient waves had amplitudes up to 800 mm H2O. Stationary waves were found only among patients with elevated intracranial pressure and a diseased brain. The waves were mainly caused by changes in cerebral blood volume probably reflecting the postural BP wave and brain autoregulation. Most patients with stationary and large transient waves also manifested clinical symptoms. These symptoms were aggravated when a craniospinal block developed in the sitting position, and were reduced or avoided when the tilting was performed slowly over 2 to 3 minutes.

Body position and cerebrospinal fluid pressure

1976 ◽  
Vol 44 (6) ◽  
pp. 698-705 ◽  
Author(s):  
Bjørn Magnaes
Keyword(s):  
Cerebrospinal Fluid ◽  
Body Position ◽  
Fluid Pressure ◽  
Lateral Position ◽  
Cervical Region ◽  
Content Type ◽  
Csf Pressure ◽  
Neurosurgical Patients ◽  
Csf Leakage ◽  
Lumbar Cerebrospinal Fluid

✓ Lumbar cerebrospinal fluid (CSF) pressure was recorded in 116 adult neurosurgical patients in the lateral and sitting positions. The level of zero CSF pressure while in the sitting position (ZPS) and hydrostatic indifferent point (HIP) for lateral and sitting positions were determined and referred to the craniospinal axis. In control patients ZPS was located mainly at the upper cervical region, and showed nearly the same variation and frequency distribution as CSF pressure in the lateral position when efforts were made to reduce sources of error and there was no orthostatic change in CSF filling pressure. Under these circumstances ZPS may be used as a variable comparable from one subject to another. In control patients the HIP was located between C-6 and T-5. In 25 hydrocephalic patients, shunting resulted in a mean caudal shift of ZPS of 244 mm, and a mean pressure fall of 126 mm H2O in the lateral position. This difference was due to a caudal shift of HIP on shunting. A caudally located ZPS was found in patients with complete cervical subarachnoid block. Prevention and treatment of CSF leakage cranial to HIP is discussed.

Changes in CSF pressure after mannitol in patients with and without elevated CSF pressure

1988 ◽  
Vol 69 (6) ◽  
pp. 869-876 ◽  
Author(s):  
Patrick Ravussin ◽  
Mounir Abou-Madi ◽  
David Archer ◽  
René Chiolero ◽  
James Freeman ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Venous Pressure ◽  
Tumor Resection ◽  
Fluid Pressure ◽  
Content Type ◽  
Csf Pressure ◽  
Arterial Blood ◽  
Group I ◽  
Group Ii ◽  
Fine Print

✓ In view of the current concern that rapid infusion of mannitol might initially aggravate intracranial hypertension, the effects of a mannitol infusion on lumbar cerebrospinal fluid pressure (CSFP) were investigated in 49 patients. The studies were performed when the patients were under general anesthesia prior to elective craniotomy for tumor resection or intracerebral aneurysm clipping. The patients were divided into two groups: 24 patients with normal CSFP (Group I, mean CSFP 10.5 mm Hg) and 25 with raised CSFP (Group II, mean CSFP 20.8 mm Hg). Measurements of CSFP, mean arterial blood pressure (MABP), and central venous pressure (CVP) were made serially during and after the infusion of 20% mannitol (1 gm ⋅ kg−1 infused over a 10-minute interval). In both groups, mannitol infusion provoked a fall in MABP and an increase in CVP. An immediate increase in CSFP was observed in Group II, whereas CSFP increased transiently but significantly in Group I. Analysis of the arterial and venous driving pressures which contribute to CSFP suggests that the transient increase in CSFP after mannitol in Group I was partly due to the increase in CVP. The presence of intracranial hypertension may thus alter the CSFP response to arterial and venous pressure changes. Cerebral blood volume (CBV) was measured in dogs in a separate study analogous to the human protocol. The CBV increased approximately 25% over control values after mannitol infusion both in the normal animals and in those with CSFP raised by an epidural balloon. The response of the CSFP to mannitol infusion differed between both groups in a fashion similar to that observed in the human subjects. Thus, differences in CBV changes after mannitol do not account for the difference in CSFP response between normal subjects and those with raised CSFP.

Clinical recording of pressure on the spinal cord and cauda equina

1982 ◽  
Vol 57 (1) ◽  
pp. 57-63 ◽  
Author(s):  
Bjørn Magnaes
Keyword(s):  
Clinical Symptoms ◽  
Fluid Pressure ◽  
Cauda Equina ◽  
Normal Pressure ◽  
Spinal Nerve ◽  
Spinal Block ◽  
Nerve Roots ◽  
Content Type ◽  
Arterial Blood ◽  
Lumbar Spinal

✓ To define the site, degree, and dynamics of mechanical compression of the spinal nerve roots, pressure was measured in 42 patients with clinical symptoms and myelographic findings indicating central lumbar spinal stenosis. Pathological pressure on the cauda equina was found in 67% of the patients. The pressure in the region of the spinal block was high during standing and walking, and in several patients exceeded mean arterial blood pressure. The block pressure was the main mechanical factor in the central part of the spinal canal causing pain and paresis. Elevated fluid pressure caudal to the block was an additional but usually subordinate factor. In 33% of the patients, normal pressure on the cauda equina was found, and lateral compression of multiple nerve roots seemed to be the only mechanical symptom-causing factor. Clinically, these patients could not be distinguished from patients with central compression. After laminectomy with decompression of the cauda equina, the field should be inspected for lateral narrowing which, if present, should be treated.

Effects of ethanol- and saline-base PGE1 on the canine cerebral circulation

1978 ◽  
Vol 48 (5) ◽  
pp. 724-729 ◽  
Author(s):  
Daniel Radawski ◽  
Robert M. Daugherty ◽  
Thomas E. Emerson
Keyword(s):  
Cerebrospinal Fluid ◽  
Carotid Arteries ◽  
Prostaglandin E ◽  
Arterial Infusion ◽  
Content Type ◽  
Csf Pressure ◽  
Arterial Blood ◽  
Anesthetized Dogs ◽  
Cerebral Vasodilation ◽  
Cerebral Vascular Resistance

✓ The effects of ethanol- and saline-base prostaglandin E1 (PGE1) on systemic arterial blood pressure (ABP), cerebral blood flow (CBF), cerebral vascular resistance (CVR), and cerebrospinal fluid (CSF) pressure were determined in anesthetized dogs. Progressively greater carotid intra-arterial infusions of ethanol-base PGE1 moderately decreased systemic ABP and CVR while perfusion of the CSF system with PGE1 moderately increased ABP and CVR; CBF was unaffected by either route of administration and CSF pressure was constant except for a slight decrease at the lowest intraventricular perfusion rate. Similar infusions of PGE1 were administered in saline-base solutions in another group of dogs. Carotid intra-arterial infusion decreased ABP and CBF moderately at the highest infusion rate and caused a transient increase in CSF pressure. Cerebrospinal fluid system perfusion increased ABP moderately but did not affect the other parameters. These data indicate that PGE1 does not have a significant effect on cerebral hemodynamics when infused via the CSF system, but may produce slight cerebral vasodilation when infused into the carotid arteries in an ethanol base. This vasodilation may be due to autoregulation.

Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: ultrasound findings during intrathecal infusion tests

1997 ◽  
Vol 87 (1) ◽  
pp. 34-40 ◽  
Author(s):  
Hans-Christian Hansen ◽  
Knut Helmke
Keyword(s):  
Cerebrospinal Fluid ◽  
Optic Nerve ◽  
Fluid Pressure ◽  
Optic Nerve Sheath ◽  
Variable Pressure ◽  
Content Type ◽  
Csf Pressure ◽  
Nerve Sheath ◽  
Intrathecal Infusion ◽  
Fine Print

✓ Raised intracranial pressure leads to increased pressure around the optic nerve (ON), which underlies the formation of papilledema and the enlargement of the dural optic nerve sheath (ONS). In clinical practice, the presence of widened ONSs is demonstrable on neuroimaging, but their relationship to cerebrospinal fluid (CSF) pressure remains unknown. The authors investigated the ONS response to pressure during CSF absorption studies in 12 patients undergoing neurological testing. The ONS diameter was evaluated by serial B-mode ultrasound scans of the anterior ON near its entry into the globe. All patients tested showed ONS diameter changes that exhibited covariance with the alteration of lumbar CSF pressure and were completely reversible during the infusion tests. The maximum difference in ONS diameter between baseline and peak pressure conditions was 1.8 mm on average (range 0.7–3.1 mm), corresponding to an average ONS diameter variation of 45% (range 15–89%). Regression analysis yielded a linear covariance between ONS diameter and CSF pressure with different slopes across subjects (0.019–0.071 mm/mm Hg, mean r = 0.78). However, this linear relationship was only present within a CSF pressure interval. This interval differed between patients: ONS dilation commenced at pressure thresholds between 15 mm Hg and 30 mm Hg and in some patients saturation of the response (constant ONS diameter) occurred between 30 mm Hg and 40 mm Hg. With a single exception, definitely enlarged ONS diameters (> 5 mm) were present when CSF pressure exceeded levels of 30 mm Hg. Retrospectively, discrimination between normal and elevated outflow resistance was possible on the basis of the ONS response to intrathecal infusion alone. It is concluded that the human ONS has sufficient elasticity to allow a detectable dilation in response to intracranial hypertension. Because of a variable pressure—diameter relationship, the subarachnoid pressure cannot be predicted exactly by single scans. Therefore, the clinical relevance of this method relies on the demonstration of pathologically enlarged sheaths or ongoing enlargement on serial ultrasonography studies.

Normal cerebrospinal fluid pressure

1974 ◽  
Vol 40 (5) ◽  
pp. 587-593 ◽  
Author(s):  
Olof Gilland ◽  
Wallace W. Tourtellotte ◽  
Lorcan O'Tauma ◽  
William G. Henderson
Keyword(s):  
Cerebrospinal Fluid ◽  
Fluid Pressure ◽  
Opening Pressure ◽  
Content Type ◽  
Individual Level ◽  
Normal Volunteers ◽  
Csf Pressure ◽  
Average Value ◽  
Young Adult Patient ◽  
The Individual

✓ The authors report studies of cerebrospinal fluid (CSF) pressure in 31 young normal volunteers. In half, a 22-gauge needle was used, and in the other half a 26-gauge needle. The opening CSF pressure was monitored for 10 minutes and also in some during the CSF withdrawal period and the 10-minute CSF reformation period. Cardiac CSF pulse amplitudes and Queckenstedt responses following the opening pressure-monitoring period were also recorded before and after the fluid withdrawal. The average opening pressure was 14.5 cm of 0.15 M sodium chloride (S.D., 3.7) with the 22-gauge needle, and 15.7 cm (S.D., 3.6) in subjects receiving the 26-gauge needle. In each subject the opening pressure tended to fluctuate around a characteristic individual level; in five perfectly relaxed normal volunteers an average value of 20 cm was observed, with a maximal value of 24 cm. The amplitude of the cardiac pulse had a direct relationship to the individual CSF pressure. CSF was withdrawn at two different rates; both withdrawal rates generated approximately linear pressure decay curves. When the withdrawal rates were 5 and 1 ml/min, the average decline of pressure at the end of the period was 9.2 and 5.2 cm respectively. The mean CSF pressures increased only slightly during the 10-minute CSF reformation period. The data obtained should help to define whether a young adult patient does indeed have a CSF pressure elevation.

Venous and CSF pressure in cerebral infarction with a hemorrhagic component

1985 ◽  
Vol 66 (6) ◽  
pp. 419-421
Author(s):  
A. A. Ashman
Keyword(s):  
Cerebrospinal Fluid ◽  
Ischemic Stroke ◽  
Cerebral Infarction ◽  
Fluid Pressure ◽  
Cerebrospinal Fluid Pressure ◽  
Csf Pressure

Literature data on the value of cerebrospinal fluid pressure in certain forms of ischemic stroke are few and contradictory.

Digital manometry to measure cerebrospinal fluid pressure during lumbar puncture

2021 ◽  
pp. 197140092110551
Author(s):  
Robert Heider ◽  
Peter G Kranz ◽  
Erin Hope Weant ◽  
Linda Gray ◽  
Timothy J Amrhein
Keyword(s):  
Cerebrospinal Fluid ◽  
Lumbar Puncture ◽  
Pressure Measurement ◽  
Fluid Pressure ◽  
Cerebrospinal Fluid Pressure ◽  
Pressure Measurements ◽  
Csf Pressure ◽  
Left Lateral Decubitus Position ◽  
Significant Difference ◽  
Time Savings

Rationale and Objectives Accurate cerebrospinal fluid (CSF) pressure measurements are critical for diagnosis and treatment of pathologic processes involving the central nervous system. Measuring opening CSF pressure using an analog device takes several minutes, which can be burdensome in a busy practice. The purpose of this study was to compare accuracy of a digital pressure measurement device with analog manometry, the reference gold standard. Secondary purpose included an assessment of possible time savings. Materials and Methods This study was a retrospective, cross-sectional investigation of 71 patients who underwent image-guided lumbar puncture (LP) with opening CSF pressure measurement at a single institution from June 2019 to September 2019. Exclusion criteria were examinations without complete data for both the digital and analog measurements or without recorded needle gauge. All included LPs and CSF pressures were measured with the patient in the left lateral decubitus position, legs extended. Acquired data included (1) digital and analog CSF pressures and (2) time required to measure CSF pressure. Results A total of 56 procedures were analyzed in 55 patients. There was no significant difference in mean CSF pressures between devices: 22.5 cm H2O digitally vs 23.1 analog ( p = .7). Use of the digital manometer resulted in a time savings of 6 min (438 s analog vs 78 s digital, p < .001). Conclusion Cerebrospinal fluid pressure measurements obtained with digital manometry demonstrate comparable accuracy to the reference standard of analog manometry, with an average time savings of approximately 6 min per case.

Mechanism by which positive end-expiratory pressure increases cerebrospinal fluid pressure in dogs

1982 ◽  
Vol 52 (1) ◽  
pp. 231-235 ◽  
Author(s):  
J. M. Luce ◽  
J. S. Huseby ◽  
W. Kirk ◽  
J. Butler
Keyword(s):  
Cerebrospinal Fluid ◽  
Superior Vena Cava ◽  
Subarachnoid Space ◽  
Superior Vena ◽  
Fluid Pressure ◽  
Vena Cava ◽  
Cerebrospinal Fluid Pressure ◽  
Positive End Expiratory Pressure ◽  
Arterial Blood ◽  
Before And After

We investigated possible mechanisms by which positive end-expiratory pressure (PEEP) increased cerebrospinal fluid pressure (PCSF) in anesthetized mechanically ventilated dogs. In part I of the study, PEEP was applied in 5 cmH2O increments each lasting 1–2 min, before and after a snare separated the spinal from the cerebral subarachnoid space in each animal. Next, with the spinal cord still ligated, the dogs were ventilated without PEEP while superior vena cava pressure (PSVC) was raised in 5 cmH2O increments by means of a fluid reservoir connected with the superior vena cava. Cerebrospinal fluid pressure in the cisterna magna increased immediately and in parallel with PEEP before and after the spinal subarachnoid space was occluded and also increased when PSVC was raised independently; in all circumstances the increase in PCSF correlated closely with PSVC (r = 0.926). In part II of the study, arterial blood gases were drawn before and after PEEP was applied in the same increments and for the same duration as in part I. Cerebrospinal fluid pressure measured with a hollow skull screw again rose in parallel with PEEP, whereas arterial carbon dioxide tension rose only slightly at 60 s. In part III of the study, mean arterial pressure (Pa) was allowed to decrease with PEEP or was held constant by distal aortic obstruction and volume infusion. Cerebrospinal fluid pressure increased regardless of Pa, but the increase was greater when Pa was held constant than when it fell with PEEP. We conclude that PEEP increases PCSF primarily by increasing PSVC and decreasing cerebral venous outflow. This effect is augmented if cerebral arterial inflow is increased as well.

Bacterial meningitis caused by the use of ventricular or lumbar cerebrospinal fluid catheters

2005 ◽  
Vol 102 (2) ◽  
pp. 229-234 ◽  
Author(s):  
Rogier P. Schade ◽  
Janke Schinkel ◽  
Leo G. Visser ◽  
J. Marc C. van Dijk ◽  
Joan H. C. Voormolen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Clinical Symptoms ◽  
External Drainage ◽  
Content Type ◽  
Ventricular Catheters ◽  
Independent Risk Factors ◽  
Lumbar Cerebrospinal Fluid ◽  
Fine Print

Object. In the present study the authors compared the incidence and risk factors for external drainage—related bacterial meningitis (ED-BM) by using ventricular and lumbar catheters. Methods. A cohort of 230 consecutive patients with ED was evaluated. Cerebrospinal fluid samples were obtained daily for microbiological culture, and ED-BM was defined based on culture results in combination with clinical symptoms. The incidence of ED-BM was 7% in lumbar and 15% in ventricular drains. Independent risk factors included site leakage, drain blockage, and most importantly duration of ED. Despite a higher infection rate, ventricular catheters did not have a significant higher risk of infection after correcting for duration of drainage. Conclusions. Analysis of data in the present study showed that the incidence of ED-associated death is low (0.45%) in patients who do not receive continuous antibiotic prophylaxis during ED.

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