Medical & Biological Engineering & Computing

, Volume 52, Issue 1, pp 75–85 | Cite as

CSF dynamic analysis of a predictive pulsatility-based infusion test for normal pressure hydrocephalus

  • Sara Qvarlander
  • Jan Malm
  • Anders Eklund
Original Article


Disturbed cerebrospinal fluid (CSF) dynamics are part of the pathophysiology of normal pressure hydrocephalus (NPH) and can be modified and treated with shunt surgery. This study investigated the contribution of established CSF dynamic parameters to AMPmean, a prognostic variable defined as mean amplitude of cardiac-related intracranial pressure pulsations during 10 min of lumbar constant infusion, with the aim of clarifying the physiological interpretation of the variable. AMPmean and CSF dynamic parameters were determined from infusion tests performed on 18 patients with suspected NPH. Using a mathematical model of CSF dynamics, an expression for AMPmean was derived and the influence of the different parameters was assessed. There was high correlation between modelled and measured AMPmean (r = 0.98, p < 0.01). Outflow resistance and three parameters relating to compliance were identified from the model. Correlation analysis of patient data confirmed the effect of the parameters on AMPmean (Spearman’s ρ = 0.58–0.88, p < 0.05). Simulated variations of ±1 standard deviation (SD) of the parameters resulted in AMPmean changes of 0.6–2.9 SD, with the elastance coefficient showing the strongest influence. Parameters relating to compliance showed the largest contribution to AMPmean, which supports the importance of the compliance aspect of CSF dynamics for the understanding of the pathophysiology of NPH.


Cerebrospinal fluid dynamics Prognostic tests Intracranial pressure Normal pressure hydrocephalus 



This project was financed by the Swedish Research Council, VINNOVA, and the Swedish Foundation for Strategic Research through their common initiative: “Biomedical engineering for improved health”; and by the European Union through ERDF: Objective 2, Northern Sweden.


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Copyright information

© International Federation for Medical and Biological Engineering 2013

Authors and Affiliations

  1. 1.Department of Radiation Sciences - Biomedical EngineeringUmeå UniversityUmeåSweden
  2. 2.Centre of Biomedical Engineering and PhysicsUmeå UniversityUmeåSweden
  3. 3.Department of Clinical NeuroscienceUmeå UniversityUmeåSweden

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