Advertisement

The relationship between CSF circulation and cerebrovascular pressure-reactivity in normal pressure hydrocephalus

  • Z. CzosnykaEmail author
  • F. van den Boogaard
  • M. Czosnyka
  • S. Momjian
  • L. Gelling
  • J. D. Pickard
Part of the Acta Neurochirurgica Supplementum book series (NEUROCHIRURGICA, volume 95)

Summary

Objective

Previously, we documented association between CSF circulation and transcranial-Doppler derived autoregulation in non-shunted patients suffering from hydrocephalus. In the present study we sought to investigate the relationship between the resistance to CSF outflow and pressure-reactivity both in shunted and non-shunted NPH patients.

Material and methods

Sixty-eight patients (47 non-shunted and 21 shunted) with NPH have been examined as a part of routine diagnostic procedure. Resistance to CSF outflow (Rcsf) was measured using a ventricular constant rate infusion test. Cerebrovascular pressure-reactivity was assessed as a moving correlation coefficient (PRx) between coherent ‘slow waves’ of ICP and arterial blood pressure (ABP). This variable has previously been demonstrated to correlate with the autoregulation of CBF in patients following head injury.

Results

In non-shunted patients cerebrovascular pressure-reactivity (PRx) was negatively correlated with Rcsf (R = −0.5; p < 0.0005). This relationship was inverted in shunted patients: a positive correlation between PRx and Rcsf was found (R = 0.51; p < 0.03).

Conclusion

Cerebrovascular pressure-reactivity is disturbed in patients with normal resistance to CSF outflow, suggesting underlying cerebrovascular disease. This result confirms our previous finding where transcranial Doppler autoregulation was investigated. After shunting the pressure-reactivity strongly depends on shunt functioning and deteriorates when the shunt is blocked.

Keywords

Hydrocephalus autoregulation CSF flow shunt 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Boon AJ, Tans JT, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer HA, Hermans J (1999) Dutch normal-pressure hydrocephalus study: the role of cerebrovascular disease. J Neurosurg 90: 221–226PubMedGoogle Scholar
  2. 2.
    Boon AJ, Tans JT, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer HA, Avezaat CJ, de Jong DA, Gooskens RH, Hermans J (1997) Dutch normal-pressure hydrocephalus study: prediction of outcome after shunting by resistance to outflow of cerebrospinal fluid. J Neurosurg 87: 687–693PubMedCrossRefGoogle Scholar
  3. 3.
    Chang C, Kuwana N, Ito S, Ikegami T (2000) Impairment of cerebrovascular reactivity to acetazolamide in patients with normal pressure hydrocephalus. Nucl Med Commun 21(2): 139–141PubMedCrossRefGoogle Scholar
  4. 4.
    Czosnyka M, Smielewski P, Kirkpatrick P, Laing RJ, Menon D, Pickard JD (1997) Continuous assessment of the cerebral vasomotor reactivity in head injury. Neurosurgery 41(1): 11–17PubMedCrossRefGoogle Scholar
  5. 5.
    Czosnyka Z, Czosnyka M, Pickard JD (2002) Shunt testing invivo: a method based on the data from the UK shunt evaluation laboratory. Acta Neurochir [Suppl] 81: 27–30Google Scholar
  6. 6.
    Czosnyka Z, Czosnyka M, Whitfield PC, Donovan T, Pickard JD (2002) Cerebral autoregulation among patients with symptoms of hydrocephalus. Neurosurgery 50(3): 526–532PubMedCrossRefGoogle Scholar
  7. 7.
    Klinge PM, Berding G, Brinker T, Knapp WH, Samu M (1999) A PET study of cerebrovascular reserve before and after shunt surgery in patients with idiopathic chronic hydrocephalus. J Neurosurg 91(4): 605–609PubMedCrossRefGoogle Scholar
  8. 8.
    Momjian S, Owler BK, Czosnyka Z, Czosnyka M, Pena A, Pickard JD (2004) Pattern of white matter regional cerebral blood flow and autoregulation in normal pressure hydrocephalus. Brain 127 (Pt 5): 965–972PubMedCrossRefGoogle Scholar
  9. 9.
    Malm J, Kristensen B, Karlsson T, Fagerlund M, Elfverson J, Ekstedt J (1995) The predictive value of CSF dynamic tests in patients with the idiopathic hydrocephalus syndrome. Arch Neurol 52: 783–789PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Z. Czosnyka
    • 1
    Email author
  • F. van den Boogaard
    • 2
  • M. Czosnyka
    • 1
  • S. Momjian
    • 1
  • L. Gelling
    • 1
  • J. D. Pickard
    • 1
  1. 1.Academic Department of NeurosurgeryAddenbrooke’s HospitalCambridgeUK
  2. 2.Faculty of MedicineUniversity of UtrechtUtrechtThe Netherlands

Personalised recommendations