Cerebral autoregulation among patients with symptoms of hydrocephalus.

Abstract:

OBJECTIVE:To study the relationship between the resistance to cerebrospinal fluid (CSF) outflow and cerebral autoregulation. METHODS:We examined 35 patients who presented with ventricular dilation and clinical symptoms of communicating hydrocephalus. For all of these patients, CSF compensatory reserve was investigated by using a computerized infusion test, with simultaneous recording of blood flow velocity wave forms (by using transcranial Doppler ultrasonography) and arterial blood pressure (with a Finapress finger cuff). The resistance to CSF outflow was calculated as the absolute increase in intracranial pressure (interpolated over vasogenic waves) divided by the infusion rate (1.5 ml/min in most cases). The index of autoregulation was assessed as a correlation coefficient (moving time window of 5 min) between slow waves (with periods of 20 s to 2 min) in mean blood flow velocity and cerebral perfusion pressure. RESULTS:The mean intracranial pressure increased during the test, from 6 mm Hg (standard deviation, 6 mm Hg) to 20 mm Hg (standard deviation, 10 mm Hg) (P < 0.0001). The index of autoregulation was significantly correlated with the resistance to CSF outflow (r = -0.41, P < 0.03), indicating better autoregulation with greater resistance to CSF outflow. CONCLUSION:Patients presenting with ventricular dilation may exhibit either decreased (atrophy) or increased (normal-pressure hydrocephalus) resistance to CSF outflow. Increased resistance is correlated with preserved autoregulation. Patients with low resistance, suggesting brain atrophy, more often have disturbed autoregulation in the middle cerebral artery territory, as assessed by transcranial Doppler ultrasonography.

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

Czosnyka ZH,Czosnyka M,Whitfield PC,Donovan T,Pickard JD

doi

10.1097/00006123-200203000-00018

keywords:

subject

Has Abstract

pub_date

2002-03-01 00:00:00

pages

526-32; discussion 532-3

issue

3

eissn

0148-396X

issn

1524-4040

journal_volume

50

pub_type

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