Cerebral autoregulation among patients with symptoms of hydrocephalus

Czosnyka, Z., Czosnyka, M., Whitfield, P.C., Donovan, Tim and Pickard, J.D. (2002) Cerebral autoregulation among patients with symptoms of hydrocephalus. Neurosurgery, 50 (3). pp. 526-532. Full text not available from this repository.

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Official URL: https://doi.org/10.1097/00006123-200203000-00018

Abstract

Objective: To study the relationship between the resistance to cerebrospinal fluid (CSF) outflow and cerebral autoregulation.

Methods: We examined 35 patients who presented with ventricular dilation and clinical symptoms of communicating hydrocephalus. For all of these patients, CSF compensatory reserve was investigated by using a computerized infusion test, with simultaneous recording of blood flow velocity wave forms (by using transcranial Doppler ultrasonography) and arterial blood pressure (with a Finapress finger cuff). The resistance to CSF outflow was calculated as the absolute increase in intracranial pressure (interpolated over vasogenic waves) divided by the infusion rate (1.5 ml/min in most cases). The index of autoregulation was assessed as a correlation coefficient (moving time window of 5 min) between slow waves (with periods of 20 s to 2 min) in mean blood flow velocity and cerebral perfusion pressure.

Results: The mean intracranial pressure increased during the test, from 6 mm Hg (standard deviation, 6 mm Hg) to 20 mm Hg (standard deviation, 10 mm Hg) (P < 0.0001). The index of autoregulation was significantly correlated with the resistance to CSF outflow (r = -0.41, P < 0.03), indicating better autoregulation with greater resistance to CSF outflow.

Conclusion: Patients presenting with ventricular dilation may exhibit either decreased (atrophy) or increased (normal-pressure hydrocephalus) resistance to CSF outflow. Increased resistance is correlated with preserved autoregulation. Patients with low resistance, suggesting brain atrophy, more often have disturbed autoregulation in the middle cerebral artery territory, as assessed by transcranial Doppler ultrasonography.

Item Type: Article
Journal or Publication Title: Neurosurgery
Publisher: Lippincott, Williams & Wilkins for Congress of Neurological Surgeons
ISSN: 1524-4040
Departments: Faculty of Health and Science > Medical and Sports Sciences > Health and Medical Sciences
Depositing User: Insight Administrator
Date Deposited: 17 Oct 2011 09:06
Last Modified: 31 Jul 2017 15:50
URI: http://insight.cumbria.ac.uk/id/eprint/1042

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