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Phase-shift between arterial flow and ICP pulse during infusion test

  • Clinical Article - Brain Injury
  • Published:
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Abstract

Background

The dynamic relationship between pulse waveform of intracranial pressure (ICP) and transcranial Doppler (TCD) cerebral blood flow velocity (CBFV) may contain information about cerebrospinal compliance. This study investigated the possibility by focusing on the phase shift between fundamental harmonics of CBFV and ICP.

Methods

Thirty-seven normal pressure hydrocephalus patients (20 men, mean age 58) underwent the cerebrospinal fluid (CSF) infusion tests. The infusion was performed via pre-implanted Ommaya reservoir. The TCD FV was recorded in the middle cerebral artery. Resulting continuous ICP and pressure-volume (PV) signals were analyzed by ICM+ software.

Results

In initial stage of the CSF infusion, the phase shift was negative (median value = −11°, range = +60 to −117). There was significant inverse association of phase shift with brain elasticity (R = −0.51; p = 0.0009). In all tests, phase shift consistently decreased during gradual elevation of ICP (p = 0.00001). Magnitude of decrease in phase shift was inversely related to the peak-to-peak amplitude of ICP pulse waveform at a baseline (R = −0.51; p = 0.001).

Conclusions

Phase shift between fundamental harmonics of ICP and TCD waveforms decreases during elevation of ICP. This is caused by an increase of time delay between systolic peak of flow velocity wave and ICP pulse.

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Acknowledgments

This is European Community sponsored study, under the auspice of inter-regional cooperation between Amiens and Cambridge. D.J.K. and H.S.K. are sponsored by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (2013R1A1A1004827). ICM+ software used in this study is licensed by the University of Cambridge (Cambridge Enterprise). M.C. and P.S. have a financial interest in a part of its licensing fee.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Departments of Brain and Cognitive Engineering, Korea University, Anam-dong, Seongbu-gu, 136-713, Seoul, South Korea

    Dong-Joo Kim & Hakseung Kim

  2. Academic Neurosurgical Unit, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK

    Dong-Joo Kim, Marek Czosnyka, Piotr Smielewski & Zofia Czosnyka

  3. Department of Biophysics and Medical Image Processing, Center Hospital University Amiens, Amiens, France

    Olivier Balédent

  4. Division of Neurosurgery, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK

    Matthew R. Garnett

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  1. Dong-Joo Kim
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  2. Marek Czosnyka
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  3. Hakseung Kim
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  4. Olivier Balédent
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  5. Piotr Smielewski
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  6. Matthew R. Garnett
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  7. Zofia Czosnyka
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Correspondence to Dong-Joo Kim.

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Kim, DJ., Czosnyka, M., Kim, H. et al. Phase-shift between arterial flow and ICP pulse during infusion test. Acta Neurochir 157, 633–638 (2015). https://doi.org/10.1007/s00701-015-2353-4

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  • DOI: https://doi.org/10.1007/s00701-015-2353-4

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