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.

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.

scholarly journals Reference Values For Intracranial Pressure And Lumbar Cerebrospinal Fluid Pressure: A Systematic Review

2021 ◽  
Author(s):  
Nicolas Hernandez Norager ◽  
Markus Harboe Olsen ◽  
Sarah Hornshoej Pedersen ◽  
Casper Schwartz Riedel ◽  
Marek Czosnyka ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Reference Values ◽  
Supine Position ◽  
Body Position ◽  
Fluid Pressure ◽  
Reference Intervals ◽  
Cerebrospinal Fluid Pressure ◽  
Lumbar Cerebrospinal Fluid

Abstract BackgroundAlthough widely used in the evaluation of the diseased, normal intracranial pressure and lumbar cerebrospinal fluid pressure remains sparsely documented. Intracranial pressure is different from lumbar cerebrospinal fluid pressure. In addition, intracranial pressure differs considerably according to body position of the patient. Despite this, the current reference interval are used indistinguishable for intracranial and lumbar cerebrospinal fluid pressure, and body position dependent reference intervals does not exist. In this study, we aim to establish these reference intervals.MethodA systematic search was conducted in MEDLINE, EMBASE, CENTRAL, and Web of Sciences. Methodological quality was assessed using an amended version of the Joanna Briggs Quality Appraisal Checklist. Intracranial pressure and lumbar cerebrospinal fluid pressure were independently evaluated and subdivided into body positions. Quantitative data were presented with mean ± SD, and 90% reference intervals.ResultsThirty-six studies were included. Nine studies reported values for intracranial pressure, while 27 reported values for the lumbar cerebrospinal fluid pressure. Reference values for intracranial pressure were -5.9 to 8.3 mmHg in the upright position and 0.9 to 16.3 mmHg in supine position. Reference values for lumbar cerebrospinal fluid pressure were 7.2 to 16.8 mmHg and 5.7 to 15.5 mmHg in the lateral recumbent position and supine position, respectively. ConclusionsThis systematic review is the first to provide position-dependent reference values for intracranial pressure and lumbar cerebrospinal fluid pressure. Clinically applicable reference values for normal lumbar cerebrospinal fluid pressure was established, and were in accordance with previously used reference values. For intracranial pressure, this study strongly emphasizes the scarse normal material, and highlights the need for further research on the matter.

scholarly journals Reference values for intracranial pressure and lumbar cerebrospinal fluid pressure: a systematic review

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Nicolas Hernandez Norager ◽  
Markus Harboe Olsen ◽  
Sarah Hornshoej Pedersen ◽  
Casper Schwartz Riedel ◽  
Marek Czosnyka ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Reference Values ◽  
Supine Position ◽  
Body Position ◽  
Fluid Pressure ◽  
The Body ◽  
Cerebrospinal Fluid Pressure ◽  
Lumbar Cerebrospinal Fluid

Abstract Background Although widely used in the evaluation of the diseased, normal intracranial pressure and lumbar cerebrospinal fluid pressure remain sparsely documented. Intracranial pressure is different from lumbar cerebrospinal fluid pressure. In addition, intracranial pressure differs considerably according to the body position of the patient. Despite this, the current reference values do not distinguish between intracranial and lumbar cerebrospinal fluid pressures, and body position-dependent reference values do not exist. In this study, we aim to establish these reference values. Method A systematic search was conducted in MEDLINE, EMBASE, CENTRAL, and Web of Sciences. Methodological quality was assessed using an amended version of the Joanna Briggs Quality Appraisal Checklist. Intracranial pressure and lumbar cerebrospinal fluid pressure were independently evaluated and subdivided into body positions. Quantitative data were presented with mean ± SD, and 90% reference intervals. Results Thirty-six studies were included. Nine studies reported values for intracranial pressure, while 27 reported values for the lumbar cerebrospinal fluid pressure. Reference values for intracranial pressure were −  5.9 to 8.3 mmHg in the upright position and 0.9 to 16.3 mmHg in the supine position. Reference values for lumbar cerebrospinal fluid pressure were 7.2 to 16.8 mmHg and 5.7 to 15.5 mmHg in the lateral recumbent position and supine position, respectively. Conclusions This systematic review is the first to provide position-dependent reference values for intracranial pressure and lumbar cerebrospinal fluid pressure. Clinically applicable reference values for normal lumbar cerebrospinal fluid pressure were established, and are in accordance with previously used reference values. For intracranial pressure, this study strongly emphasizes the scarcity of normal pressure measures, and highlights the need for further research on the matter.

Desflurane and Isoflurane Increase Lumbar Cerebrospinal Fluid Pressure in Normocapnic Patients Undergoing Transsphenoidal Hypophysectomy

1996 ◽  
Vol 85 (5) ◽  
pp. 999-1004 ◽  
Author(s):  
P. Talke ◽  
J. Caldwell ◽  
B. Dodsont ◽  
C. A. Richardson
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Systolic Blood Pressure ◽  
Fluid Pressure ◽  
Random Order ◽  
Mass Effect ◽  
Csf Pressure ◽  
Lumbar Cerebrospinal Fluid

Background Rapid emergence from anesthesia makes desflurane an attractive choice as an anesthetic for patients having neurosurgery. However, the data on the effect of desflurane on intracranial pressure in humans are still limited and inconclusive. The authors hypothesized that isoflurane and desflurane increase intracranial pressure compared with propofol. Methods Anesthesia was induced with intravenous fentanyl and propofol in 30 patients having transsphenoidal hypophysectomy with no evidence of mass effect, and it was maintained with 70% nitrous oxide in oxygen and a continuous 100 micrograms.kg-2.min-1 infusion of propofol. Patients were assigned to three groups randomized to receive only continued propofol infusion (n = 10), desflurane (n = 10), or isoflurane (n = 10) for 20 min. During the 20-min study period, each patient in the desflurane and isoflurane groups received, in random order, two concentrations (0.5 minimum alveolar concentration [MAC] and 1.0 MAC end-tidal) of desflurane or isoflurane for 10 min each. Lumbar cerebrospinal fluid (CSF) pressure, blood pressure, heart rate, and anesthetic concentrations were monitored continuously. Results Lumbar CSF pressure increased significantly in all patients receiving desflurane or isoflurane. Lumbar CSF pressure increased by 5 +/- 3 mmHg at 1-MAC concentrations of desflurane and by 4 +/- 2 mmHg at 1-MAC concentrations of isoflurane. Cerebral perfusion pressure decreased by 12 +/- 10 mmHg at 1-MAC concentrations of desflurane and by 15 +/- 10 mmHg at 1-MAC concentrations of isoflurane. Heart rate increased by 7 +/- 9 bpm with 0.5 MAC desflurane and by 8 +/- 7 bpm with 1.0 MAC desflurane, and by 5 +/- 11 bpm with 1.0 MAC isoflurane. Systolic blood pressure decreased in all but the patients receiving 1.0 MAC desflurane. To maintain blood pressure within predetermined limits, phenylephrine was administered to six of ten patients in the isoflurane group (range, 25 to 600 micrograms), two of ten patients in the desflurane group (range, 200 to 500 micrograms), and in no patients in the propofol group. Lumbar CSF pressure, heart rate, and systolic blood pressure did not change in the propofol group. Conclusion Desflurane and isoflurane, at 0.5 and 1.0 MAC, increase lumbar CSF pressure.

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.

Acquired Chiari I malformation secondary to spontaneous spinal cerebrospinal fluid leakage and chronic intracranial hypotension syndrome in seven cases

1998 ◽  
Vol 88 (2) ◽  
pp. 237-242 ◽  
Author(s):  
John L. D. Atkinson ◽  
Brian G. Weinshenker ◽  
Gary M. Miller ◽  
David G. Piepgras ◽  
Bahram Mokri
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypotension ◽  
Chiari I Malformation ◽  
Csf Leak ◽  
Cerebrospinal Fluid Leakage ◽  
Content Type ◽  
Intracranial Hypotension Syndrome ◽  
Csf Leakage ◽  
Chiari I ◽  
Fine Print

Object. Spontaneous spinal cerebrospinal fluid (CSF) leakage with development of the intracranial hypotension syndrome and acquired Chiari I malformation due to lumbar spinal CSF diversion procedures have both been well described. However, concomitant presentation of both syndromes has rarely been reported. The object of this paper is to present data in seven cases in which both syndromes were present. Three illustrative cases are reported in detail. Methods. The authors describe seven symptomatic cases of spontaneous spinal CSF leakage with chronic intracranial hypotension syndrome in which magnetic resonance (MR) images depicted dural enhancement, brain sagging, loss of CSF cisterns, and acquired Chiari I malformation. Conclusions. This subtype of intracranial hypotension syndrome probably results from chronic spinal drainage of CSF or high-flow CSF shunting and subsequent loss of brain buoyancy that results in brain settling and herniation of hindbrain structures through the foramen magnum. Of 35 cases of spontaneous spinal CSF leakage identified in the authors' practice over the last decade, MR imaging evidence of acquired Chiari I malformation has been shown in seven. Not to be confused with idiopathic Chiari I malformation, ideal therapy requires recognition of the syndrome and treatment directed to the site of the spinal CSF leak.

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.

Lumbar Cerebrospinal Fluid Opening Pressure Measured in a Flexed Lateral Decubitus Position in Children

PEDIATRICS ◽  
1994 ◽  
Vol 93 (4) ◽  
pp. 622-623
Author(s):  
Robert Ellis
Keyword(s):  
Cerebrospinal Fluid ◽  
Intrathecal Chemotherapy ◽  
Lateral Decubitus Position ◽  
Normal Range ◽  
Opening Pressure ◽  
Csf Pressure ◽  
Normal Ranges ◽  
Extended Position ◽  
Lateral Decubitus ◽  
Lumbar Cerebrospinal Fluid

Objective. Lumbar punctures in children are generally performed in a flexed position. Published normal ranges for cerebrospinal fluid (CSF) opening pressure require measurement in an extended position, and flexion is known to increase lumbar CSF pressure. This study sought to determine a normal range (mean ± 2 SD) for lumbar CSF opening pressure measured in a flexed lateral decubitus position in children. Methods. Opening pressure was measured in 33 children receiving diagnostic lumbar punctures or prophylactic intrathecal chemotherapy. Measurements were performed in a flexed lateral decubitus position. Patients with medical conditions affecting CSF pressure were excluded. Results. Opening pressure (mean ± SD) was 19.0 ± 4.4 cm H2O. Opening pressure was not significantly affected by patient age or sex. Intrathecal chemotherapy and sedation also did not affect CSF pressure. Conclusions. The normal range for lumbar CSF opening pressure measured in a flexed lateral decubitus position in children is 10 to 28 cm H2O.

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