Summary
Objective
To test the validity of the hypothesis that active vasodilatation and vasoconstriction underlie the occurrence of intracranial pressure (ICP) plateau waves by evaluating corresponding changes of cerebrovascular pressure transmission of arterial blood pressure (ABP) to ICP.
Methods
Digitized recordings of ICP and ABP sampled at 30 Hz were obtained from nine patients with traumatic brain injury. For each 16.5 s recording interval mean values of ICP, ABP, cerebral perfusion pressure (CPP), and the corresponding highest modal frequency (HMF) of cerebrovascular pressure transmission were calculated.
Results
Mean ICP and HMF significantly increased (P<0.003) and mean CPP decreased significantly (P<0.00036) at onset of the wave. Conversely at termination, mean ICP and HMF significantly decreased (P<0.026) and mean CPP significantly increased (P<0.028). In addition, the strong negative correlations between mean ICP and mean CPP (r=−0:87) and mean HMF and CPP (r=−0:87) were demonstrated.
Conclusion
The findings that HMF increased at onset and decreased at the termination of plateau wave support the validity of the vasodilatatory/constriction cascade model that postulates active vasodilation at the onset and active vasoconstriction of the cerebrovascular bed at the termination of a plateau wave.
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References
Czosnyka M, Piechnik P, Richards HK, Kirpatrick P, Smielewski P, Pickard JD (1997) Contribution of mathematical modeling to the interpretation of bedside tests of cerebrovascular autoregulation. J Neurol Neurosurg Psychiat 63: 721–731
Czosnyka M, Smielewski P, Piechnik S, Schmidt E, Al-Rawi PG, Kirkpatrick PJ, Pickard JD (1999) Hemodynamic characterization of intracranial pressure plateau waves in head-injured patients. J Neurosurg 92: 11–19
Daley ML, Pourcyrous M, Timmons SD, Leffler CW (2004) Assessment of cerebrovascular autoregulation: changes of highest modal frequency of cerebrovascular pressure transmission with cerebral perfusion pressure. Stroke 35: 1952–1956
Ljung L (1987) Chapter 1: Introduction. In: System identification: theory for the user. Prentice Hall, Upper Saddle River, NJ, pp 1–12
Lundberg N (1960) Continuous recording and control of ventricular fluid pressure in neurological practice. Acta Psychiat Neurol Scand (Copenhagen) (thesis)
Risberg J, Lundberg N, Ingvar DH (1969) Regional cerebral blood volume during acute transient rises of the intracranial pressure (plateau waves). J Neurosurg 31(3): 303–310
Rosner MJ (1986) The vasodilatory cascade and intracranial pressure. In: Miller JD, Teasdale GM, Rowan JO (eds) Intracranial pressure VI. Springer, Berlin, pp 137–141
Rosner MJ, Becker DP (1984) Origin and evolution of plateau waves. Experimental observations and a theoretical model. J Neurosurg 60(2): 312–324
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© 2005 Springer-Verlag
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Daley, M.L., Leffler, C.W., Czosnyka, M., Pickard, J.D. (2005). Plateau waves: changes of cerebrovascular pressure transmission. In: Poon, W.S., et al. Intracranial Pressure and Brain Monitoring XII. Acta Neurochirurgica Supplementum, vol 95. Springer, Vienna. https://doi.org/10.1007/3-211-32318-X_67
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DOI: https://doi.org/10.1007/3-211-32318-X_67
Publisher Name: Springer, Vienna
Print ISBN: 978-3-211-24336-7
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