Clinical Autonomic Research

, Volume 29, Issue 1, pp 123–126 | Cite as

Changes in cardiac autonomic activity during intracranial pressure plateau waves in patients with traumatic brain injury

  • Michael M. TymkoEmail author
  • Joseph Donnelly
  • Peter Smielewski
  • Frederick A. Zeiler
  • Marek Sykora
  • Christina Haubrich
  • Nathalie Nasr
  • Marek Czosnyka
Letter to the Editor

Dear Editors,

Recent reports show that autonomic activity is altered during changes in intracranial pressure (ICP) in both animal [ 1], and human models [ 2] assessed via microneurography. In line with these studies, patients suffering from severe traumatic brain injury (TBI) often experience acute intracranial hypertensive insults called “plateau waves” [ 3]. These plateau waves are a physiological phenomenon during which ICP rapidly increases to 40–100 mmHg, resulting in a reduction in cerebral perfusion pressure and, consequently, cerebral blood flow (see Fig.  1; [ 4]). The duration of these cerebral insults can be variable, lasting from several minutes to over 30 min [ 4]. However, the physiological mechanisms underlying plateau waves and the consequences of these insults remain unclear. The current dogma for the mechanism(s) governing plateau waves can be described as a “vasodilatory cascade,” which purports a positive feedback loop potentially commenced by a brief initial...


Traumatic brain injury Sympathetic nervous activity Parasympathetic nervous activity Heart rate variability Baroreflex sensitivity 



We would like to thank all staff of the Neurosciences Critical Care Unit at Addenbrooke’s Hospital, Cambridge, UK, for their support and professional cooperation. MMT was supported by a Natural Sciences and Engineering Research Council (NSERC) Michael Smith foreign supplement travel grant. JD was supported through a Woolf Fisher scholarship. FAZ was supported through the Cambridge Commonwealth Trust Scholarship, the Royal College of Surgeons of Canada—Harry S. Morton Travelling Fellowship in Surgery and the University of Manitoba Clinician Investigator Program.

Author contribution

MMT, JD and MC were responsible for conception and design of the current study. All authors contributed to the analysis and interpretation of the data and drafted the article or critically revised it for important intellectual content. All authors approved the final version of the manuscript, and all person designated as authors qualify for authorship. All those who qualify for authorship are listed.

Compliance with ethical standards

Conflict of Interest

ICM+ software is licensed by the University of Cambridge, Cambridge Enterprise Ltd. MC and PS have a financial interest in a part of its licensing fee.

Supplementary material

10286_2018_579_MOESM1_ESM.docx (22 kb)
Supplementary material 1 (DOCX 22 kb)


  1. 1.
    Guild SJ, Saxena UA, McBryde FD, Malpas SC, Ramchandra R (2018) Intracranial pressure influences the level of sympathetic tone. Am J Physiol Regul Integr Comp Physiol. Google Scholar
  2. 2.
    Schmidt EA, Despas F, Pavy-Le Traon A et al (2018) Intracranial pressure is a determinant of sympathetic activity. Front Physiol 9:11CrossRefGoogle Scholar
  3. 3.
    Lundberg N (1960) Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Scand Suppl 36(149):1–193Google Scholar
  4. 4.
    Castellani G, Zweifel C, Kim DJ et al (2009) Plateau waves in head injured patients requiring neurocritical care. Neurocrit Care 11(2):143–150CrossRefGoogle Scholar
  5. 5.
    Rosner MJ, Becker DP (1984) Origin and evolution of plateau waves. Experimental observations and a theoretical model. J Neurosurg 60(2):312–324CrossRefGoogle Scholar
  6. 6.
    Willie CK, Tzeng YC, Fisher JA, Ainslie PN (2014) Integrative regulation of human brain blood flow. J Physiol 592(5):841–859CrossRefGoogle Scholar
  7. 7.
    Sykora M, Czosnyka M, Liu X et al (2016) Autonomic impairment in severe traumatic brain injury: a multimodal neuromonitoring study. Crit Care Med 44(6):1173–1181CrossRefGoogle Scholar
  8. 8.
    Mortara A, La Rovere MT, Pinna GD et al (1997) Arterial baroreflex modulation of heart rate in chronic heart failure: clinical and hemodynamic correlates and prognostic implications. Circulation 96(10):3450–3458CrossRefGoogle Scholar
  9. 9.
    Robinson TG, Dawson SL, Eames PJ, Panerai RB, Potter JF (2003) Cardiac baroreceptor sensitivity predicts long-term outcome after acute ischemic stroke. Stroke 34(3):705–712CrossRefGoogle Scholar
  10. 10.
    Eckberg DL (1997) Sympathovagal balance: a critical appraisal. Circulation 96(9):3224–3232CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, Faculty of Health and Social DevelopmentUniversity of British ColumbiaKelownaCanada
  2. 2.Department of Clinical NeurosciencesCambridge UniversityCambridgeUK
  3. 3.Division of Anaesthesia, Department of MedicineUniversity of CambridgeCambridgeUK
  4. 4.Department of Surgery, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegCanada
  5. 5.Clinician Investigator Program, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegCanada
  6. 6.Department of Neurology, St. John’s Hospital, Faculty of MedicineSigmund Freud UniversityViennaAustria
  7. 7.Faculty of MedicineUniversity of AachenAachenGermany
  8. 8.Unité de Neurologie Vasculaire, Département de NeurologieCHU de ToulouseToulouseFrance
  9. 9.INSERM U1048, Team 08 (I2MC-Toulouse)Université de Toulouse IIIToulouseFrance

Personalised recommendations