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Increased Intracranial Pressure Attenuates the Pulsating Component of Cerebral Venous Outflow

BACKGROUND: The underlying physiology of the intracranial pressure (ICP) curve morphology is still poorly understood. If this physiology is explained it could be possible to extract clinically relevant information from the ICP curve. The venous outflow from the cranial cavity is pulsatile, and in th...

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Autores principales: Unnerbäck, Mårten, Ottesen, Johnny T., Reinstrup, Peter
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6757136/
https://www.ncbi.nlm.nih.gov/pubmed/31240621
http://dx.doi.org/10.1007/s12028-019-00733-4
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author Unnerbäck, Mårten
Ottesen, Johnny T.
Reinstrup, Peter
author_facet Unnerbäck, Mårten
Ottesen, Johnny T.
Reinstrup, Peter
author_sort Unnerbäck, Mårten
collection PubMed
description BACKGROUND: The underlying physiology of the intracranial pressure (ICP) curve morphology is still poorly understood. If this physiology is explained it could be possible to extract clinically relevant information from the ICP curve. The venous outflow from the cranial cavity is pulsatile, and in theory the pulsatile component of venous outflow from the cranial cavity should be attenuated with increasing ICP. In this study, we explored the relationship between ICP and the pulsatility of the venous outflow from the intracranial cavity. METHODS: Thirty-seven neuro-intensive care patients that had been examined with phase-contrast magnetic resonance imaging regarding cerebral blood flow (CBF) through the internal carotid and vertebral arteries and venous flow in the internal jugular veins were retrospectively included. The pulsatility of the jugular flow was determined by calculating the venous pulsatile index. The results were correlated to clinical data registered in the patient data monitoring system, including ICP and cerebral perfusion pressure (CPP). RESULTS: CBF was 996 ± 298 ml/min, and the flow in the internal jugular veins equaled 67 ± 17% of the CBF, with a range of 22–97%. The venous pulsatile index correlated negatively to ICP (R = − 0.47 p = 0.003). The lowest flow in the internal jugular veins over the cardiac cycle (F(min)) was not correlated to ICP. Temperature, end-tidal CO(2), MAP, and CPP were not correlated to venous pulsatility. CONCLUSION: An increase in ICP correlates to a lower pulsatility of the venous outflow from the cranial cavity. A lower pulsatility could be due to increased pressure requirements to compress intracranial veins with increasing ICP.
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spelling pubmed-67571362019-10-07 Increased Intracranial Pressure Attenuates the Pulsating Component of Cerebral Venous Outflow Unnerbäck, Mårten Ottesen, Johnny T. Reinstrup, Peter Neurocrit Care Original Work BACKGROUND: The underlying physiology of the intracranial pressure (ICP) curve morphology is still poorly understood. If this physiology is explained it could be possible to extract clinically relevant information from the ICP curve. The venous outflow from the cranial cavity is pulsatile, and in theory the pulsatile component of venous outflow from the cranial cavity should be attenuated with increasing ICP. In this study, we explored the relationship between ICP and the pulsatility of the venous outflow from the intracranial cavity. METHODS: Thirty-seven neuro-intensive care patients that had been examined with phase-contrast magnetic resonance imaging regarding cerebral blood flow (CBF) through the internal carotid and vertebral arteries and venous flow in the internal jugular veins were retrospectively included. The pulsatility of the jugular flow was determined by calculating the venous pulsatile index. The results were correlated to clinical data registered in the patient data monitoring system, including ICP and cerebral perfusion pressure (CPP). RESULTS: CBF was 996 ± 298 ml/min, and the flow in the internal jugular veins equaled 67 ± 17% of the CBF, with a range of 22–97%. The venous pulsatile index correlated negatively to ICP (R = − 0.47 p = 0.003). The lowest flow in the internal jugular veins over the cardiac cycle (F(min)) was not correlated to ICP. Temperature, end-tidal CO(2), MAP, and CPP were not correlated to venous pulsatility. CONCLUSION: An increase in ICP correlates to a lower pulsatility of the venous outflow from the cranial cavity. A lower pulsatility could be due to increased pressure requirements to compress intracranial veins with increasing ICP. Springer US 2019-06-25 2019 /pmc/articles/PMC6757136/ /pubmed/31240621 http://dx.doi.org/10.1007/s12028-019-00733-4 Text en © The Author(s) 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Work
Unnerbäck, Mårten
Ottesen, Johnny T.
Reinstrup, Peter
Increased Intracranial Pressure Attenuates the Pulsating Component of Cerebral Venous Outflow
title Increased Intracranial Pressure Attenuates the Pulsating Component of Cerebral Venous Outflow
title_full Increased Intracranial Pressure Attenuates the Pulsating Component of Cerebral Venous Outflow
title_fullStr Increased Intracranial Pressure Attenuates the Pulsating Component of Cerebral Venous Outflow
title_full_unstemmed Increased Intracranial Pressure Attenuates the Pulsating Component of Cerebral Venous Outflow
title_short Increased Intracranial Pressure Attenuates the Pulsating Component of Cerebral Venous Outflow
title_sort increased intracranial pressure attenuates the pulsating component of cerebral venous outflow
topic Original Work
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6757136/
https://www.ncbi.nlm.nih.gov/pubmed/31240621
http://dx.doi.org/10.1007/s12028-019-00733-4
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