Increased ICP and Its Cerebral Haemodynamic Sequelae

Joseph Donnelly , Marek Czosnyka , Spencer Harland , Georgios V Varsos , Danilo Cardim , Chiara Robba , X. Liu , Philip N. Ainslie , Peter Smielewski

Abstract

Objectives: Increased intracranial pressure (ICP) is a pathological feature of many neurological diseases; however, the local and systemic sequelae of raised ICP are incompletely understood. Using an experimental paradigm, we aimed to describe the cerebrovascular consequences of acute increases in ICP. Materials and methods: We assessed cerebral haemodynamics [mean arterial blood pressure (MAP), ICP, laser Doppler flowmetry (LDF), basilar artery Doppler flow velocity (Fv) and estimated vascular wall tension (WT)] in 27 basilar artery-dependent rabbits during experimental (artificial lumbar CSF infusion) intracranial hypertension. WT was estimated as the difference between critical closing pressure and ICP. Results: From baseline (~9 mmHg) to moderate increases in ICP (~41 mmHg), cortical LDF decreased (from 100 to 39.1%, p < 0.001), while mean global Fv was unchanged (from 47 to 45 cm/s, p = 0.38). In addition, MAP increased (from 88.8 to 94.2 mmHg, p < 0.01 and WT decreased (from 19.3 to 9.8 mmHg, p < 0.001). From moderate to high ICP (~75 mmHg), both global Fv and cortical LDF decreased (Fv, from 45 to 31.3 cm/s, p < 0.001; LDF, from 39.1 to 13.3%, p < 0.001) while MAP increased further (94.2 to 114.5 mmHg, p < 0.001) and estimated WT was unchanged (from 9.7 to 9.6 mmHg, p = 0.35). Conclusion: In this analysis, we demonstrate a cortical vulnerability to increases in ICP and two ICP-dependent cerebro-protective mechanisms: with moderate increases in ICP, WT decreases and MAP increases to buffer cerebral perfusion, while with severe increases of ICP, an increased MAP predominates.
Author Joseph Donnelly - [University of Cambridge]
Joseph Donnelly,,
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, Marek Czosnyka (FEIT / PE)
Marek Czosnyka,,
- The Institute of Electronic Systems
, Spencer Harland - [Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust]
Spencer Harland,,
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, Georgios V Varsos - [University of Cambridge]
Georgios V Varsos,,
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, Danilo Cardim - [University of Cambridge]
Danilo Cardim,,
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, Chiara Robba - [University of Cambridge]
Chiara Robba,,
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, X. Liu - [University of Cambridge]
X. Liu,,
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, Philip N. Ainslie - [The University of British Columbia]
Philip N. Ainslie,,
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, Peter Smielewski - [University of Cambridge]
Peter Smielewski,,
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Pages47-50
Publication size in sheets0.5
Book Heldt Thomas (eds.): Intracranial Pressure & Neuromonitoring XVI, Acta Neurochirurgica, Supplement, vol. 126, 2018, Springer International Publishing, ISBN 978-3-319-65797-4, [978-3-319-65798-1], DOI:10.1007/978-3-319-65798-1
Keywords in EnglishIntracranial pressure; Cerebral haemodynamics; Autoregulation; Cerebral perfusion pressure
ASJC Classification2728 Clinical Neurology; 2746 Surgery
DOIDOI:10.1007/978-3-319-65798-1_10
URL https://link.springer.com/chapter/10.1007%2F978-3-319-65798-1_10
Languageen angielski
Score (nominal)5
Score sourcepublisherList
ScoreMinisterial score = 5.0, 20-10-2019, MonographChapterAuthor
Publication indicators Scopus Citations = 0; Scopus SNIP (Source Normalised Impact per Paper): 2017 = 0.44
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