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Increased ICP and Its Cerebral Haemodynamic Sequelae

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Intracranial Pressure & Neuromonitoring XVI

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 126))

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.

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Conflicts of interest statement

ICM+ software (Cambridge Enterprise, Cambridge, UK, http://www.neurosurg.cam.ac.uk/icmplus/) is a multimodal data acquisition and analysis software licensed by the University of Cambridge, Cambridge Enterprise Ltd. P.S. and M.C. have a financial interest in part of the licensing fee. The remaining authors declare no relevant competing financial interests.

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Authors and Affiliations

  1. Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge Biomedical Campus, University of Cambridge, Cambridge, CB2 0QQ, UK

    Joseph Donnelly, Marek Czosnyka, Georgios V. Varsos, Danilo Cardim, Chiara Robba, Xiuyun Liu & Peter Smielewski

  2. Institute of Electronic Systems, Warsaw University of Technology, Warsaw, Poland

    Marek Czosnyka

  3. Queen Elizabeth Hospital, Birmingham, UK

    Spencer Harland

  4. University of British Columbia, Kelowna, BC, Canada

    Philip N. Ainslie

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  1. Joseph Donnelly
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  2. Marek Czosnyka
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  3. Spencer Harland
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  4. Georgios V. Varsos
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  5. Danilo Cardim
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  6. Chiara Robba
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  7. Xiuyun Liu
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  8. Philip N. Ainslie
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  9. Peter Smielewski
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Correspondence to Joseph Donnelly .

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Editors and Affiliations

  1. Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA

    Thomas Heldt

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Donnelly, J. et al. (2018). Increased ICP and Its Cerebral Haemodynamic Sequelae. In: Heldt, T. (eds) Intracranial Pressure & Neuromonitoring XVI. Acta Neurochirurgica Supplement, vol 126. Springer, Cham. https://doi.org/10.1007/978-3-319-65798-1_10

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  • DOI: https://doi.org/10.1007/978-3-319-65798-1_10

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-65797-4

  • Online ISBN: 978-3-319-65798-1

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