Document Detail

Pulse amplitude of intracranial pressure waveform in hydrocephalus.
MedLine Citation:
PMID:  19388305     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: There is increasing interest in evaluation of the pulse amplitude of intracranial pressure (AMP) in explaining dynamic aspects of hydrocephalus. We reviewed a large number of ICP recordings in a group of hydrocephalic patients to assess utility of AMP.
MATERIALS AND METHODS: From a database including approximately 2,100 cases of infusion studies (either lumbar or intraventricular) and overnight ICP monitoring in patients suffering from hydrocephalus of various types (both communicating and non-communicating), etiology and stage of management (non-shunted or shunted) pressure recordings were evaluated. For subgroup analysis we selected 60 patients with idiopathic NPH with full follow-up after shunting. In 29 patients we compared pulse amplitude during an infusion study performed before and after shunting with a properly functioning shunt. Amplitude was calculated from ICP waveforms using spectral analysis methodology.
FINDINGS: A large amplitude was associated with good outcome after shunting (positive predictive value of clinical improvement for AMP above 2.5 mmHg was 95%). However, low amplitude did not predict poor outcome (for AMP below 2.5 mmHg 52% of patients improved). Correlations of AMP with ICP and Rcsf were positive and statistically significant (N = 131 with idiopathic NPH; R = 0.21 for correlation with mean ICP and 0.22 with Rcsf; p< 0.01). Correlation with the brain elastance coefficient (or PVI) was not significant. There was also no significant correlation between pulse amplitude and width of the ventricles. The pulse amplitude decreased (p < 0.005) after shunting.
CONCLUSIONS: Interpretation of the ICP pulse waveform may be clinically useful in patients suffering from hydrocephalus. Elevated amplitude seems to be a positive predictor for clinical improvement after shunting. A properly functioning shunt reduces the pulse amplitude.
Z Czosnyka; N Keong; D J Kim; D Radolovich; P Smielewski; A Lavinio; E A Schmidt; S Momjian; B Owler; J D Pickard; M Czosnyka
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Acta neurochirurgica. Supplement     Volume:  102     ISSN:  0065-1419     ISO Abbreviation:  Acta Neurochir. Suppl.     Publication Date:  2008  
Date Detail:
Created Date:  2009-04-24     Completed Date:  2009-06-10     Revised Date:  2014-02-19    
Medline Journal Info:
Nlm Unique ID:  100962752     Medline TA:  Acta Neurochir Suppl     Country:  Austria    
Other Details:
Languages:  eng     Pagination:  137-40     Citation Subset:  IM    
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MeSH Terms
Aged, 80 and over
Blood Pressure
Cerebrospinal Fluid Shunts / methods
Databases, Bibliographic / statistics & numerical data
Hydrocephalus / classification,  physiopathology*,  surgery
Intracranial Pressure / physiology*
Magnetic Resonance Imaging
Middle Aged
Monitoring, Physiologic
Transducers, Pressure
Young Adult
Grant Support
G9439390//Medical Research Council

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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