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PubMed1987

Intracranial flow patterns at increasing intracranial pressure.

In the course of a pilot study, changes in intracranial pressure were compared with the transcranial Doppler findings of the middle cerebral artery. The cases of five patients were discussed who developed dissociated brain death in spite of intensive therapeutic measures. The studies showed that changes of the intracranial pressure influenced the flow patterns considerably: at increasing intracranial pressure (decreasing cerebral perfusion pressure) a progressive reduction of the systolic and above all diastolic flow velocities and finally a pendular flow occurred. These changes could be recorded quantitatively by means of the "Pourcelot index" and the mean flow velocity. Acute changes of the intracranial pressure can be detected at an early stage by noninvasive transcranial Doppler studies and can be followed by adequate intensive therapy.

Adult↗

PubMed1995

Intracranial pressure waveform indices in transient and refractory intracranial hypertension.

Analysis of data obtained by continuous computerized monitoring of intracranial pressure (ICP) in 109 adult patients with severe head trauma was performed to examine the pattern of change in indices of the ICP waveform. Indices derived from direct measurement of the ICP wave and obtained from a Fast Fourier Transform (FFT) were examined. Concurrent physiologic measurements were made. Two types of intracranial hypertension (ICH) were defined for comparison. 'Transient intracranial hypertension' occurred when an abrupt rise in ICP was followed by a return to below 25 mm Hg (n = 63). Increases in ICP that were progressive and led to neurologic deterioration and death were termed 'refractory intracranial hypertension' (n = 18). During transient ICH heart rate, arterial pressure, end-tidal carbon dioxide and jugular venous oxygen saturation all increased, while these measures either were unchanged or decreased during refractory ICH. The pulse amplitude of the ICP wave increased in both types of ICHtn. Other changes in the waveform indices were consistent with this change in pulse amplitude. HFC responded differently to the two types of changes, with an increase during the transient changes and a decrease during the refractory changes. The differences in changes in physiologic measurements as ICH occurred in the 2 groups suggest that in refractory ICH cerebral blood flow is maintained against the mounting ICP, while in transient ICH the hypertension is caused by an increase in cerebral blood flow. The waveform indices do not discriminate between the two types of changes.

Adult↗

PubMed1992

Relationships between dopamine infusions and intracranial hemodynamics in patients with raised intracranial pressure.

Dopamine, 1-10 micrograms/kg body weight/min was infused in 6 patients suffering from cerebrovascular diseases with elevated intracranial pressure and a critical cerebral perfusion pressure. Dopamine decreased intracranial pressure in 3 and increased it moderately in the other 3 patients. In all patients, the dopamine-induced rise of mean arterial pressure led to an increase of cerebral perfusion pressure. Transcranial Doppler ultrasonographic recordings of the middle cerebral artery in patients whose intracranial pressure declined revealed a decrease of the pathologically elevated cerebrovascular resistance, and an augmentation of cerebral blood supply. In conclusion, dopamine infusions may improve cerebral hemodynamics in some patients with severe brain edema. Such patients can be identified by intracranial pressure and Doppler monitoring.

Blood Flow Velocity↗

PubMed1992

Alfentanil increases intracranial pressure when intracranial compliance is low.

Intracranial pressure increases following the administration of alfentanil 1 mg are reported in five patients with suspected normal pressure hydrocephalus who were undergoing infusion of saline into a lateral ventricle to measure cerebrospinal fluid outflow resistance. The increase in intracranial pressure was accompanied by a fall in mean arterial pressure. These observations show that, when the intracranial compliance is reduced, alfentanil can cause considerable increases in intracranial pressure and decreases in cerebral perfusion pressure.

Aged↗

PubMed1977

Systemic vascular responses to increased intracranial pressure. 1. Effects of progressive epidural ballon expansion on intracranial pressure: and systemic circulation.

This paper details the results of experimental studies, on 16 dogs with artificially-induced intracranial space-occupying lesions, of the systemic vascular responses and the intracranial pressure changes (both in the supratentorial and infratentorial compartments) induced by increasing intracranial pressure. The changes produced were divided into two phases such that phase 1 detailed the alterations observed from the start of the balloon inflation up to the initiation of the systemic pressor response. Phase 2 recorded those alterations which occurred during, and immediately after, the period of systemic hypertension (see Fitch et al., 1977). The changes observed during phase 1, and presented in this communication, were those of increasing intracranial pressures and decreasing mean arterial pressure and heart rate. These alterations were associated with decreases in supratentorial perfusion pressure and increases in transtentorial pressure gradient and arrhythmia index.

Animals↗

PubMed2005

Is non-invasive monitoring of intracranial pressure waveform analysis possible? Preliminary results of a comparative study of non-invasive vs. invasive intracranial slow-wave waveform analysis monitoring in patients with traumatic brain injury.

BACKGROUND: An increasing body of evidence supports the concept that intracranial pressure (ICP) slow B waves represent the auto-regulatory response of spontaneous fluctuations of cerebral perfusion pressure. A relationship between cerebral auto-regulation and clinical outcome in patients with traumatic brain injury has also been established. The objective of our prospective clinical study was to compare the B slow ICP waves obtained invasively by standard ICP monitoring to those obtained noninvasively using a new ultrasound technology. MATERIAL/METHODS: In the participating institutions, over a period of six months, thirteen consecutive patients (8 males and 5 females) with severe closed head injuries (GCS < 8) were included in our IRB-approved study. Intracranial pressure and B slow waves, as well as arterial blood pressure and waveforms, were evaluated by standard invasive techniques. Additionally, a new non-invasive ultrasound device, Vittamed (Telematics Scientific Laboratory, Kaunas, Lithuania), was employed for monitoring intracranial blood volume slow waves. Using these modalities, it was possible to compare the changes that occurred with invasive monitoring (Correlation factor RI) and the changes that occurred using non-invasive technology (Correlation factor RN). RESULTS: Bland Altman plot analysis showed positive correlation between the invasively and non-invasively obtained slow intracranial B waves (2sigma = 8.9%, p < 0.0001) and cerebral auto-regulation indexes (RI and RN) (SD = 5%, p < 0.0001). Positive RI and RN values were correlated with poor clinical outcome. CONCLUSIONS: Ultrasonographic technology (Vittamed) may have significant application in non-invasive continuous cerebrovascular auto-regulation monitoring in patients with severe head injuries.

Adolescent↗

PubMed2006

[Different methods of intracranial-extracranial bypass surgery for the treatment of intracranial aneurysms].

OBJECTIVE: To investigate the effects and methods of intracranial-extracranial (IC-EC) bypass surgery in the treatment of intracranial aneurysms. METHODS: The clinical material of 9 cases, who performed IC-EC bypass surgery before occlusion of the parental arteries of intracranial aneurysms, was studied retrospectively, especially how to evaluate the co-lateral circulation of the parental arteries and how to select the different methods of IC-EC bypass surgery. RESULTS: The co-lateral circulation in 9 cases was not enough to meet the need of the cerebral blood flow after occlusion of the parental arteries of the aneurysms. Revascularization by different methods of IC-EC bypass surgery and then occlusion of the parental arteries, ischemia in the brain area feeding by occluded parental arteries of the aneurysms did not occurred. CONCLUSION: When the co-lateral circulation of the parental arteries of intracranial aneurysm is not enough, the revascularization by different methods of IC-EC bypass surgery is needed before occlusion of these arteries.

Adolescent↗

PubMed2003

Prospective, population-based detection of intracranial vascular malformations in adults: the Scottish Intracranial Vascular Malformation Study (SIVMS).

BACKGROUND AND PURPOSE: Intracranial vascular malformations (IVMs) are an important cause of intracranial hemorrhage, epilepsy, and long-term disability in adults. There are no published prospective, population-based studies dedicated to the detection of any type of IVM (cavernous malformations, venous malformations, and arteriovenous malformations [AVMs] of the brain or dura). Therefore, we established the Scottish Intracranial Vascular Malformation Study (SIVMS) to monitor detection and long-term prognosis of people with IVMs. METHODS: We used multiple overlapping sources of case ascertainment to identify adults (aged >or=16 years) with a first-ever-in-a-lifetime diagnosis of any type of IVM made between January 1, 1999, and December 31, 2000, while resident in Scotland (mid-1999 adult population estimate 4,110,956). RESULTS: Of 418 notifications to SIVMS, 190 adults (45%) were included, 181 (95%) of whom were deemed to harbor a definite IVM after review of diagnostic brain imaging and/or reports of autopsy/surgical excision pathology. The crude detection rate (per 100,000 adults per year) was 2.27 (95% CI, 1.96 to 2.62) for all IVMs, 1.12 (95% CI, 0.90 to 1.37) for brain AVMs, 0.56 (95% CI, 0.41 to 0.75) for cavernous malformations, 0.43 (95% CI, 0.31 to 0.61) for venous malformations, and 0.16 (95% CI, 0.08 to 0.27) for dural AVMs. CONCLUSIONS: In addition to providing data on the public health importance and comparative epidemiology of IVMs, continuing recruitment and follow-up of this prospective, population-based cohort will provide estimates of IVM prognosis.

Adolescent↗

PubMedDate not supplied

Validation of increased intracranial pressure and high risk for increased intracranial pressure.

The authors designed this validation study to determine the defining characteristics of increased intracranial pressure and the risk factors for high risk for increased intracranial pressure. Using Fehring's Diagnostic Content Validity Model, a purposive sample of 219 nurses validated 17 major and 16 minor defining characteristics of increased intracranial pressure and nine major and six minor risk factors for high risk for increased intracranial pressure. Ratings were similar among nurses with diverse educational preparation but varied among nurses in different specialty areas, suggesting that practice setting is important in nursing diagnosis validation studies.

Humans↗

PubMed1988

The minor symptoms of increased intracranial pressure: 101 patients with benign intracranial hypertension.

Of 101 patients with benign intracranial hypertension not related to vasculitis, neck stiffness occurred in 31, tinnitus in 27, distal extremity paresthesias in 22, joint pains in 13, low back pain in 5, and gait "ataxia" in 4. Symptoms resolved promptly upon lowering the intracranial pressure by lumbar puncture, and were probably directly caused by intracranial hypertension. Awareness of these "minor" symptoms of increased intracranial pressure can facilitate diagnosis and management.

Adolescent↗

PubMed1984

Results of extracranial-intracranial arterial bypass for intracranial internal carotid artery stenosis: review of 105 cases.

Extracranial-intracranial arterial bypass was performed for intracranial internal carotid artery stenosis in 105 patients who had ischemic symptoms 1 to 3 months before operation. The degree of stenosis, measured angiographically, was 60 to 98%. The postoperative bypass patency rate, determined angiographically or by Doppler examination, was 97%. The surgical mortality rate was 1%, and the permanent surgical morbidity rate was 2%. During a mean follow-up period of 54 months, 22 patients died; 10 deaths were caused by cardiac disease and 3 were related to stroke, 2 of which were ipsilateral to the bypass. One patient was lost to follow-up. Seventy-three of the 82 survivors (89%) had no further transient ischemic attacks or stroke after operation. Seven patients had a late stroke: 5 were ipsilateral, 1 was contralateral, and 1 was vertebrobasilar. Three of these strokes were fatal. The overall late death rate was 4% per year, and the late death rate from neurological causes was 0.6% per year. The late stroke rate was 1.5% per year, and the rate of ipsilateral late stroke in patients who had a patent bypass was 0.6% per year. We conclude that extracranial-intracranial arterial bypass for symptomatic intracranial internal carotid artery stenosis is a reasonably safe and technically satisfactory procedure that has a potential for improving outcome, compared with the natural history of the disease.

Adult↗

PubMed1996

Transcranial duplex-sonography in intracranial hemorrhage. Evaluation of transcranial duplex-sonography in the diagnosis of spontaneous and traumatic intracranial hemorrhage.

The aim of this prospective clinical study was to evaluate the potential of bedside transcranial color-coded duplex sonography (TDS) in the assessment of patients with acute intracranial hemorrhage and respective complications. 74 patients (35 with spontaneous and 27 with traumatic hemorrhage, 12 excluded due to insufficient insonability) underwent 152 TDS examinations. The results were compared to computer-tomography (CT) as well as conventional transcranial Doppler sonography (TcD). The size and localisation of intracerebral hemorrhages as detected in TDS coincided in 39/42 examinations with CT findings; in cases of traumatic intracranial extracerebral hematoma TDS correlated in all but one case (18/19). The TDS findings for the diameter of third and lateral ventricles (n = 126) as for midline-shift (n = 26) showed a good correlation (p < 0.0005) to CT-measurements. TDS appears to be a useful bedside, non-invasive tool in order to detect and exclude intracranial complications in patients with intracranial hemorrhages.

Cerebral Hemorrhage↗

PubMed1998

Does the size of intracranial aneurysms change with intracranial pressure? Observations based on color "power" transcranial Doppler ultrasound.

OBJECT: The authors sought to determine whether the increased pulsatility of aneurysms, compared with normal intracranial arteries, on color "power" transcranial Doppler (TCD) ultrasound was due to a true change in aneurysm size and whether aneurysm dimensions change with intracranial pressure (ICP). METHODS: The authors studied nine patients who had suffered recent subarachnoid hemorrhages complicated by hydrocephalus requiring intraventricular cerebrospinal fluid drainage, in whom the presence of an aneurysm was confirmed on angiographic examination. Color "power" TCD studies of the intracranial arteries and aneurysm were obtained through the temporal bone window before and after insertion of the ventricular drain and then at different known ICPs. Of the nine patients studied, four were examined both before and after insertion of a ventricular drain. At high ICPs, aneurysms appeared very "pulsatile" and the maximum cross-sectional area was small, whereas at low ICPs, aneurysms appeared larger and were much less pulsatile. The normal arteries did not change significantly in terms of pulsatility or maximum cross-sectional area at different levels of ICP. CONCLUSIONS: The change in aneurysm size visualized with the aid of color power TCD is likely to be real. Aneurysm dimensions vary with ICP levels; the lesions are larger and less pulsatile at low ICPs and smaller but more pulsatile at high ICPs.

Anatomy, Cross-Sectional↗

PubMed2005

[Value of serial CT scanning and intracranial pressure monitoring for detecting new intracranial mass effect in severe head injury patients showing lesions type I-II in the initial CT scan].

OBJECTIVE: To determine the incidence of pathological and intracranial pressure (ICP) changes during the acute posttraumatic period in severe head injury patients presenting with lesions Types I-II (TCDB classification) in the admission CT scan with the aim of defining the most appropriate strategy of sequential CT scanning and ICP monitoring for detecting new intra-cranial mass effect and improving the final outcome. MATERIAL AND METHODS: 56 patients (ages 15-80 years) consecutively admitted during a 2 years period were included. All had the initial CT scan < 24 hours after injury (mean interval = 150 min), several CT controls within the first days of the course and ICP monitoring after admission. Different epidemiological, clinical and radiological variables were recorded and deterioration defined as the development of sustained ICP over 20 mmHg requiring aggressive medical and/or surgical treatment was considered the dependent variable. Uni and multivariate analyses were made for determining the correlation between different parameters and the occurrence of deterioration and the final outcome as assessed with the GOS. RESULTS: The mean GCS score was 5 and 37% of the patients showed pupillary changes; 52.3% had peritraumatic hypotension-hypoxemia, 16.1% anemia and 12.3% coagulation changes. 50% of the patients showed petechial hemorrhages in the white matter or the brainstem, 66% SAH, 40% HIV, 39.3% brain contusion and 21.4% small extraaxial hematomas. 57.1% of the patients showed CT changes through the acute post-traumatic period consisting of new contusion (26.8% of the cases), growing of previous contusion (68.2%) or previous extraaxial hematoma (10.7%), and generalized brain swelling (10.7%). 64.9% of the patients made a favourable and 35.7% an unfavourable outcome. Overall, 27 (48.9%) patients developed deterioration, 21 (37.5%) with concurrent CT changes and 6 (10.7%) without new pathology as seen by the CT control. The remaining 29 (51.7%) patients in this series did not develop deterioration in spite that 11(19.6%) showed CT changes. The age, the initial score, the occurrence of peritraumatic hypotension-hypoxemia and coagulation disorders did not correlate with the risk of deterioration. By contrast, the presence of contusion at the initial CT scan (p= 0.01) and the occurrence of CT change (only generalized brain swelling, p= 0.003) significantly correlated with the risk of deterioration; in his turn deterioration increased by a factor of 10 (OR = 9.8) the risk of death and 7 out of the 8 patients who died developed intractable intracranial hypertension. The 8 (14.2%) patients requiring surgery showed simultaneous ICP deterioration and CT changes, but another 11 patients in a similar condition could be managed without surgery. With or without ICP deterioration, patients showing CT changes had a worse outcome than those without new pathologies, but the difference did not reach statistical significance, DISCUSSION AND CONCLUSIONS: Over 50% of the patients with initial Type I-II lesions developed new CT changes and nearly 50% showed intracranial hypertension during the acute posttraumatic period. Considering the high incidences of ICP and CT deterioration through the course, along with the absence of strong predictors and the discordances between CT and ICP changes (which were seen in 30.3% of the cases) we recommend ICP monitoring after admission in all patients and serial CT scanning at 2-4, 12, 24, 48 and 72 hours after injury with additional controls as indicated by clinical or ICP changes in all cases. Though it is clear that the presence of severe intra-cranial hypertension significantly increased the risk of death, the small size of the sample in this series prevented to assess to what extent the occurrence of new mass effect and/or raised ICP contributed to the development of moderate and severe disability in the survivors which were mainly due to the occurrence of diffuse axonal injury. Finally, demonstrating that sequential CT scanning and ICP monitoring improve the final outcome in this type of patients would require a prospective randomized trial which is impracticable for different reasons, among them the ethical ones.

Adolescent↗

PubMed1995

Bedside measurement of the third ventricle's diameter during episodes of arising intracranial pressure after head trauma. Using transcranial real-time sonography for a non-invasive examination of intracranial compensation mechanisms.

Using transcranial real-time sonography, changes in the axial diameter of the third ventricle during manoeuvres, which increased intracranial pressure (ICP), were measured in 28 patients with moderate to severe head injury. The measurements were correlated with ICP measured by epidural pressure monitoring. We observed reductions in diameter ranging from 0.3 to 1.1 mm with rises in intracranial pressure of at least 5 mm in 22 patients of whom only one died. In 6 additional patients, no changes in diameter were seen, and 5 of the 6 died. We interpret that poor outcome as a measurable inability for the brain to expel cerebrospinal fluid into extracerebral compartments during increased ICP. Transcranial real-time sonography may provide additional information about intracranial cerebral fluid dynamics and compliance.

Adolescent↗

PubMed2000

Intracranial pressure and clinical status: assessment of two intracranial pressure transducers.

The aim of this study was to determine the in vivo accuracy and reliability of intracranial pressure (ICP) measurement using the Codman MicroSensor by comparison with the Camino ICP transducer and associated clinical and radiological information. Paired ICP readings were recorded every minute in 17 patients. A total of 56,790 validated paired measurements were obtained over a wide range of ICP values (- 16 mm Hg to 114 mm Hg). Recording periods ranged from 3 hours to 6 days (median 41 hours). In 11 patients the MicroSensor and Camino readings were in good agreement. Paired readings were within 10 mmHg for 99% of the recording time and both readings were compatible with clinical intracranial events at all times (in one case it was not possible to verify the clinical information). In six patients large differences occurred between transducer readings (> 10 mm Hg apart for 41% of the recording period). In one case, either reading could have been compatible with intracranial clinical events. In two cases, although both readings were comparable, Camino readings were more consistent with clinical and radiological findings. In three cases, the MicroSensor readings were inconsistent with the clinical condition of the patients whereas the Camino readings were compatible. These results suggest that, during routine clinical use in our department, the MicroSensor provided misleading information in 18% of our patients and thus is not sufficiently reliable for routine use in the detection of adverse clinical events.

Adolescent↗

PubMed1982

Effect of labetalol on intracranial pressure in dogs with and without intracranial hypertension.

Intracranial pressure measurements and ventricular volume pressure response curves were made during induced hypotension with labetalol, a combined alpha- and beta-adrenoceptor antagonist, in dogs without (group I) and with (group II) intracranial hypertension. The administration of 600 mg labetalol resulted in a percentage decrease of mean systemic arterial blood pressure (MAP) of 27% (+/- 10%) in group I, and 32% (+/- 9%) in group II from control values without changes in intracranial pressure and the ventricular volume pressure response curve. Larger decreases in MAP were not possible, even with a dose 3 times that clinically recommended. Labetalol may be a safe hypotensive agent to supplement neurolept analgesia, but it is not the drug of choice to induce deliberate hypotension.

Animals↗

PubMed1978

Systemic vascular responses to increased intracranial pressure. 3. Effects of individual balloon inflations on intracranial pressure and the systemic circulation.

The effects of discrete increases in the volume of an artificial space-occupying lesion on intracranial pressures and the systemic circulation were studied in six anaesthetised and artificially ventilated dogs. Each increase in volume, accompanied by an increase in supratentorial intracranial pressure, a decrease in supratentorial perfusion pressure, and an increase in transtentorial pressure gradient, induced alterations in the systemic circulation. There were a decrease in heart rate, marked alterations in the arrhythmia index, and increases in stroke volume and systemic vascular resistance. A period of transient systemic hypertension was noted to accompany each discrete increase in intracranial pressure.

Animals↗