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Increased ICP and Its Cerebral Haemodynamic Sequelae.

Accepted version
Peer-reviewed

Type

Article

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Authors

Harland, Spencer 
Varsos, Georgios V 
Cardim, Danilo 

Abstract

OBJECTIVES: Increased intracranial pressure (ICP) is a pathological feature of many neurological diseases; however, the local and systemic sequelae of raised ICP are incompletely understood. Using an experimental paradigm, we aimed to describe the cerebrovascular consequences of acute increases in ICP. MATERIALS AND METHODS: We assessed cerebral haemodynamics [mean arterial blood pressure (MAP), ICP, laser Doppler flowmetry (LDF), basilar artery Doppler flow velocity (Fv) and estimated vascular wall tension (WT)] in 27 basilar artery-dependent rabbits during experimental (artificial lumbar CSF infusion) intracranial hypertension. WT was estimated as the difference between critical closing pressure and ICP. RESULTS: From baseline (~9 mmHg) to moderate increases in ICP (~41 mmHg), cortical LDF decreased (from 100 to 39.1%, p < 0.001), while mean global Fv was unchanged (from 47 to 45 cm/s, p = 0.38). In addition, MAP increased (from 88.8 to 94.2 mmHg, p < 0.01 and WT decreased (from 19.3 to 9.8 mmHg, p < 0.001). From moderate to high ICP (~75 mmHg), both global Fv and cortical LDF decreased (Fv, from 45 to 31.3 cm/s, p < 0.001; LDF, from 39.1 to 13.3%, p < 0.001) while MAP increased further (94.2 to 114.5 mmHg, p < 0.001) and estimated WT was unchanged (from 9.7 to 9.6 mmHg, p = 0.35). CONCLUSION: In this analysis, we demonstrate a cortical vulnerability to increases in ICP and two ICP-dependent cerebro-protective mechanisms: with moderate increases in ICP, WT decreases and MAP increases to buffer cerebral perfusion, while with severe increases of ICP, an increased MAP predominates.

Description

Keywords

Autoregulation, Cerebral haemodynamics, Cerebral perfusion pressure, Intracranial pressure, Animals, Arterial Pressure, Basilar Artery, Brain, Cerebral Cortex, Cerebrovascular Circulation, Hemodynamics, Intracranial Hypertension, Intracranial Pressure, Laser-Doppler Flowmetry, Rabbits

Journal Title

Acta Neurochir Suppl

Conference Name

Journal ISSN

0065-1419
2197-8395

Volume Title

126

Publisher

Springer International Publishing
Sponsorship
Medical Research Council (G0600986)
Medical Research Council (G0600986/1)