Analysis of the cerebrospinal fluid pulse wave in intracranial pressure

1983 ◽  
Vol 59 (5) ◽  
pp. 817-821 ◽  
Author(s):  
Erico R. Cardoso ◽  
Jack O. Rowan ◽  
Sam Galbraith
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Pulse Wave ◽  
Cerebrovascular Reactivity ◽  
Ventricular Catheter ◽  
Benign Intracranial Hypertension ◽  
Content Type ◽  
Voluntary Hyperventilation ◽  
Head Elevation ◽  
Fine Print

✓ The configuration of the intracranial pressure (ICP) pulse wave represents a complex sum of various components. Amplitude variations of an isolated component might reflect changes in a specific intracranial structure. Fifteen awake patients suffering from hydrocephalus, benign intracranial hypertension, or head injury underwent ICP monitoring through a ventricular catheter and were subjected to three standardized maneuvers to alter the intracranial dynamics: head elevation, voluntary hyperventilation, and cerebrospinal fluid (CSF) withdrawal. A 12° head elevation and fractionated CSF withdrawal caused a mild ICP drop and a proportionate amplitude reduction of all the wave components. Voluntary hyperventilation caused a comparable fall in ICP, and a disproportionate reduction in the amplitude of the wave components, especially the P2 component. It is postulated that the decrease in amplitude of the P2 component reflects the reduction of the cerebral bulk caused by hyperventilation. Head elevation and CSF withdrawal caused a decrease of global ICP but no specific changes in any intracranial structure, and consequently the configuration of the pulse wave remained unchanged. The establishment of relationships between anatomical substrate and particular wave components is promising since potentially it could be useful for monitoring conditions such as vasoparalysis, impaired cerebrovascular reactivity, and cerebral edema.

Management of proximal shunt obstruction

1988 ◽  
Vol 68 (5) ◽  
pp. 817-819 ◽  
Author(s):  
Charles C. Duncan
Keyword(s):  
Cerebrospinal Fluid ◽  
Fluid Flow ◽  
Intracranial Pressure ◽  
Signs And Symptoms ◽  
Ventricular Catheter ◽  
Shunt Failure ◽  
Content Type ◽  
Cerebrospinal Fluid Flow ◽  
Shunt Obstruction ◽  
Fine Print

✓ Proximal shunt obstruction or obstruction of the ventricular catheter may present with signs and symptoms of shunt failure with either no cerebrospinal fluid flow or a falsely low intracranial pressure (ICP) upon shunt tap. The author reports a technique for lowering the ICP and for measuring the pressure in patients with such obstruction by cannulation of the reservoir and ventricular catheter to penetrate into the ventricle with a 3½-in. No. 22 spinal needle. The findings in 20 cases in which this approach was utilized are summarized.

A clinical comparison of subdural screw pressure measurements with ventricular pressure

1983 ◽  
Vol 58 (1) ◽  
pp. 45-50 ◽  
Author(s):  
A. David Mendelow ◽  
John O. Rowan ◽  
Lilian Murray ◽  
Audrey E. Kerr
Keyword(s):  
Head Injury ◽  
Intracranial Pressure ◽  
Severe Head Injury ◽  
Fluid Pressure ◽  
Ventricular Catheter ◽  
Pressure Measurements ◽  
Content Type ◽  
Single Lumen ◽  
Ventricular Fluid Pressure ◽  
Fine Print

✓ Simultaneous recordings of intracranial pressure (ICP) from a single-lumen subdural screw and a ventricular catheter were compared in 10 patients with severe head injury. Forty-one percent of the readings corresponded within the same 10 mm Hg ranges, while 13% of the screw pressure measurements were higher and 46% were lower than the associated ventricular catheter measurements. In 10 other patients, also with severe head injury, pressure measurements obtained with the Leeds-type screw were similarly compared with ventricular fluid pressure. Fifty-eight percent of the dual pressure readings corresponded, while 15% of the screw measurements were higher and 27% were lower than the ventricular fluid pressure, within 10-mm Hg ranges. It is concluded that subdural screws may give unreliable results, particularly by underestimating the occurrence of high ICP.

Pneumocephalus following ventriculoperitoneal shunt

1975 ◽  
Vol 43 (5) ◽  
pp. 631-633 ◽  
Author(s):  
Lawrence H. Pitts ◽  
Charles B. Wilson ◽  
Herbert H. Dedo ◽  
Robert Weyand
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Ventriculoperitoneal Shunt ◽  
Cerebrospinal Fluid Leakage ◽  
Congenital Defects ◽  
Content Type ◽  
Ventriculoperitoneal Shunting ◽  
Tegmen Tympani ◽  
Temporal Bones ◽  
Fine Print

✓ The authors describe a case of massive pneumocephalus following ventriculoperitoneal shunting for hydrocephalus. After multiple diagnostic and surgical procedures, congenital defects in the tegmen tympani of both temporal bones were identified as the sources for entry of air. A functioning shunt intermittently established negative intracranial pressure and allowed ingress of air through these abnormalities; when the shunt was occluded, air did not enter the skull, and there was no cerebrospinal fluid leakage. Repair of these middle ear defects prevented further recurrence of pneumocephalus.

Cerebrospinal fluid edema: a rare complication of shunt operations for hydrocephalus

1982 ◽  
Vol 57 (5) ◽  
pp. 697-700 ◽  
Author(s):  
Yasuhiro Chiba ◽  
Hiroshi Takagi ◽  
Fumoto Nakajima ◽  
Satoshi Fujii ◽  
Takao Kitahara ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
White Matter ◽  
Rare Complication ◽  
Shunt Revision ◽  
Ventricular Catheter ◽  
Shunt Operation ◽  
Low Density ◽  
Content Type ◽  
Low Density Area ◽  
Fine Print

✓ Three cases are presented in which a rare complication occurred after a shunt operation for hydrocephalus. On postoperative computerized tomography (CT) scans, extensive low-density areas appeared in the white matter along the ventricular catheter. After shunt revision, gradual resolution or disappearance of the low-density area was clearly demonstrated on CT. In one patient, a collection of cerebrospinal fluid (CSF) was confirmed at operation and appeared to lie in the extracellular spaces of the white matter. The phenomenon is considered to be localized CSF edema, different from porencephaly.

Benign intracranial hypertension with spinal and radicular pain

1982 ◽  
Vol 57 (6) ◽  
pp. 833-836 ◽  
Author(s):  
Marco Bortoluzzi ◽  
Leonardo Di Lauro ◽  
Giovanni Marini
Keyword(s):  
Cerebrospinal Fluid ◽  
Serum Albumin ◽  
Intracranial Hypertension ◽  
Spinal Pain ◽  
Radicular Pain ◽  
Benign Intracranial Hypertension ◽  
Csf Flow ◽  
Content Type ◽  
Csf Absorption ◽  
Fine Print

✓ A case of benign intracranial hypertension with polyradiculopathy and spinal pain is reported. Radioactive iodinated serum albumin (RISA) cisternography demonstrated the absence of cerebrospinal fluid (CSF) flow into the intracranial cisterns, and gave evidence of CSF absorption through the spinal arachnoid villi.

Downregulation of cerebrospinal fluid production in patients with chronic hydrocephalus

2002 ◽  
Vol 97 (6) ◽  
pp. 1271-1275 ◽  
Author(s):  
Gerald D. Silverberg ◽  
Stephen Huhn ◽  
Richard A. Jaffe ◽  
Steven D. Chang ◽  
Thomas Saul ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Production Rate ◽  
Ventricular Catheter ◽  
Chronic Hydrocephalus ◽  
Production Rates ◽  
Normal Range ◽  
Content Type ◽  
Fluid Production ◽  
Csf Production ◽  
Fine Print

Object. The goal of this study was to determine the effect of hydrocephalus on cerebrospinal fluid (CSF) production rates in patients with acute and chronic hydrocephalus. Methods. The authors studied CSF production both in patients presenting with acute and chronic hydrocephalus, and patients with Parkinson disease (PD) of a similar mean age, whose CSF production was known to be normal. A modification of the Masserman method was used to measure CSF production through a ventricular catheter. The CSF production rates (means ± standard deviations) in the three groups were then compared. The patients with PD had a mean CSF production rate of 0.42 ± 0.13 ml/minute; this value lies within the normal range measured using this technique. Patients with acute hydrocephalus had a similar CSF production rate of 0.4 ± 0.13 ml/minute, whereas patients with chronic hydrocephalus had a significantly decreased mean CSF production rate of 0.25 ± 0.08 ml/minute. Conclusions. The authors postulate that chronic increased intracranial pressure causes downregulation of CSF production.

Pneumocephalus in patients with CSF shunts

1985 ◽  
Vol 63 (4) ◽  
pp. 532-536 ◽  
Author(s):  
John R. Ruge ◽  
Leonard J. Cerullo ◽  
David G. McLone
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Mental Status ◽  
Aqueductal Stenosis ◽  
Increased Intracranial Pressure ◽  
Csf Shunts ◽  
Content Type ◽  
Presenting Symptoms ◽  
Fine Print

✓ The authors present two cases of pneumocephalus occurring in patients with permanent shunts and review nine previously reported cases. Mental status changes and headache are the most common presenting symptoms. Six of the 11 cases of pneumocephalus occurred in patients with shunt placement for hydrocephalus secondary to aqueductal stenosis. In these patients, thinned cerebrospinal fluid barriers secondary to longstanding increased intracranial pressure may predispose them to pneumocephalus. Temporary extraventricular drainage is an effective method of treatment in this group of patients. Two other etiologies are identified with significance to treatment, and the role of craniotomy is discussed.

Cerebral perfusion pressure, intracranial pressure, and head elevation

1986 ◽  
Vol 65 (5) ◽  
pp. 636-641 ◽  
Author(s):  
Michael J. Rosner ◽  
Irene B. Coley
Keyword(s):  
Intracranial Pressure ◽  
Cerebral Perfusion Pressure ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Pressure Waves ◽  
Content Type ◽  
Arterial Blood ◽  
Head Elevation ◽  
Adequate Hydration ◽  
Fine Print

✓ Previous investigations have suggested that intracranial pressure waves may be induced by reduction of cerebral perfusion pressure (CPP). Since pressure waves were noted to be more common in patients with their head elevated at a standard 20° to 30°, CPP was studied as a function of head position and its effect upon intracranial pressure (ICP). In 18 patients with varying degrees of intracranial hypertension, systemic arterial blood pressure (SABP) was monitored at the level of both the head and the heart. Intracranial pressure and central venous pressure were assessed at every 10° of head elevation from 0° to 50°. For every 10° of head elevation, the average ICP decreased by 1 mm Hg associated with a reduction of 2 to 3 mm Hg CPP. The CPP was not beneficially affected by any degree of head elevation. Maximal CPP (73 ± 3.4 mm Hg (mean ± standard error of the mean)) always occurred with the head in a horizontal position. Cerebrospinal fluid pressure waves occurred in four of the 18 patients studied as a function of reduced CPP caused by head elevation alone. Thus, elevation of the head of the bed was associated with the development of CPP decrements in all cases, and it precipitated pressure waves in some. In 15 of the 18 patients, CPP was maintained by spontaneous 10- to 20-mm Hg increases in SABP, and pressure waves did not occur if CPP was maintained at 70 to 75 mm Hg or above. It is concluded that 0° head elevation maximizes CPP and reduces the severity and frequency of pressure-wave occurrence. If the head of the bed is to be elevated, then adequate hydration and avoidance of pharmacological agents that reduce SABP or prevent its rise are required to maximize CPP.

Experimental intracranial hypertension due to vascular blockade

1970 ◽  
Vol 33 (2) ◽  
pp. 156-166 ◽  
Author(s):  
J. Donald McQueen ◽  
Lawrence F. Jelsma ◽  
Fernando Bacci ◽  
Isauro Pereira
Keyword(s):  
Blood Pressure ◽  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Cerebral Edema ◽  
Content Type ◽  
Vascular Bed ◽  
Pressor Responses ◽  
Pressure Transmission ◽  
Fine Print

✓ High intracranial hypertension was induced in dogs by intracarotid injections of oil. Cerebrospinal fluid pressures continued to rise as Cushing pressor responses were evoked, but were not exceeded by the blood pressure. Transmission of blood pressure through a dilated vascular bed has been suggested as the mechanism. There was no correlation between levels of cerebral edema and the rise in intracranial pressure. This increase in pressure due to vascular blockade has been differentiated from that caused by subarachnoid blockade.

An investigation of structural degradation of cerebrospinal fluid shunt valves performed using scanning electron microscopy and energy-dispersive x-ray microanalysis

2004 ◽  
Vol 100 (3) ◽  
pp. 534-540 ◽  
Author(s):  
Spyros Sgouros ◽  
Susan J. Dipple
Keyword(s):  
Electron Microscopy ◽  
Scanning Electron Microscopy ◽  
Cerebrospinal Fluid ◽  
Energy Dispersive ◽  
Ventricular Catheter ◽  
Content Type ◽  
X Ray ◽  
Programmable Valve ◽  
Fine Print ◽  
Scanning Electron

Object. Surveys of cerebrospinal fluid (CSF) shunts that have been removed from patients have shown that even when the ventricular catheter is the cause of the obstruction, the valve may be obstructed or underperforming. The aim of this pilot study was to investigate the degradation of shunt valve structure over time due to the deposition of debris. The findings were compared with findings in unused valves. Methods. Scanning electron microscopy was used to visualize the structures of the valves. The items that were examined included two unused and nine explanted cylindrical medium pressure valves, one unused and six explanted Delta 1.5 valves (PS Medical, Goleta, CA), and one explanted Medos Programmable valve (Codman Johnson & Johnson, LeLocle, Switzerland). The valves were cut open, disassembled, and coated in gold. The areas that were analyzed included the main valve chamber, the diaphragm unit, and the antisiphon device. For areas with abnormal deposits, energy-dispersive x-ray microanalysis was performed to establish the chemical composition of the deposits. The reference unused valves had smooth surfaces with no deposits in any areas. All explanted valves had extensive deposits in all surveyed areas. The deposits varied from small clusters of crystals to large areas that displayed a cobblestone appearance. In diaphragm valves the deposits extensively affected the surface of the diaphragm and the gap between the diaphragm and the surrounding case, where normally CSF flows; in the Medos valve the deposits affected in the spring and “staircase” unit. Deposits were present as early as 2 weeks after implantation. On some valves there was a complete film covering the entire outlet of the valve, which formed a cast inside the valve stretching from wall to wall. The deposits consisted mostly of sodium and chloride, but occasionally contained calcium. In all infected and some noninfected valves there was a significant peak of carbon, indicating the presence of protein deposits. Conclusions. It appears that the continuous flow of CSF through shunt valves causes surface deposits of sodium chloride and other crystals on all aspects of the valve, including the outlet pathways. The formation of deposits may be encouraged by the adhesive properties of the materials that constitute the valve parts.

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