Assessment of Craniospinal Pressure-volume Indices

Overview

Journal AJNR Am J Neuroradiol

Specialty Neurology

Date 2010 Jul 3

PMID 20595369

Citations 19

Authors

A Wahlin

K Ambarki

R Birgander

N Alperin

J Malm

A Eklund

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: The PVI(CC) of the craniospinal compartment defines the shape of the pressure-volume curve and determines the damping of cyclic arterial pulsations. Despite no reports of direct measurements of the PVI(CC) among healthy elderly, it is believed that a change away from adequate accommodation of cardiac-related pulsations may be a pathophysiologic mechanism seen in neurodegenerative disorders such as Alzheimer disease and idiopathic normal pressure hydrocephalus. In this study, blood and CSF flow measurements are combined with lumbar CSF infusion measurements to assess the craniospinal PVI(CC) and its distribution of cranial and spinal compartments in healthy elderly.

Materials And Methods: Thirty-seven healthy elderly were included (60-82 years of age). The cyclic arterial volume change and the resulting shift of CSF to the spinal compartment were quantified by PC-MR imaging. In addition, each subject underwent a lumbar CSF infusion test in which the magnitude of cardiac-related pulsations in intracranial pressure was quantified. Finally, the PVI was calculated by using a mathematic model.

Results: After excluding 2 extreme values, the craniospinal PVI(CC) was calculated to a mean of 9.8 ± 2.7 mL and the estimated average 95% confidence interval of individual measurements was ± 9%. The average intracranial and spinal contributions to the overall compliance were 65% and 35% respectively (n = 35).

Conclusions: Combining lumbar CSF infusion and PC-MR imaging proved feasible and robust for assessment of the craniospinal PVI(CC). This study produced normative values and showed that the major compensatory contribution was located intracranially.

Citing Articles

B-waves in noninvasive capacitance signal correlate with B-waves in ICP.

Spiegelberg A, Boraschi A, Amirah R, Wolf K, Shah M, Krismer L Acta Neurochir (Wien). 2025; 167(1):60.

PMID: 40048032 PMC: 11885407. DOI: 10.1007/s00701-025-06461-3.

Modeling CSF circulation and the glymphatic system during infusion using subject specific intracranial pressures and brain geometries.

Dreyer L, Eklund A, Rognes M, Malm J, Qvarlander S, Stoverud K Fluids Barriers CNS. 2024; 21(1):82.

PMID: 39407250 PMC: 11481529. DOI: 10.1186/s12987-024-00582-0.

Assessing Cerebral Microvascular Volumetric Pulsatility with High-Resolution 4D CBV MRI at 7T.

Guo F, Zhao C, Shou Q, Jin N, Jann K, Shao X medRxiv. 2024; .

PMID: 39281763 PMC: 11398588. DOI: 10.1101/2024.09.04.24313077.

Changes of cerebrospinal fluid pressure gradient in different body positions under experimental impairment of cerebrospinal fluid pathway: new insight into hydrocephalus development.

Jurjevic I, Oreskovic D, Rados M, Brgic K, Klarica M Front Mol Neurosci. 2024; 17:1397808.

PMID: 38947218 PMC: 11212498. DOI: 10.3389/fnmol.2024.1397808.

Embracing uncertainty in cerebrospinal fluid dynamics: A Bayesian approach to analysing infusion studies.

Chabros J, Placek M, Chu K, Beqiri E, Hutchinson P, Czosnyka Z Brain Spine. 2024; 4:102837.

PMID: 38868599 PMC: 11166691. DOI: 10.1016/j.bas.2024.102837.

References

Eklund A, Smielewski P, Chambers I, Alperin N, Malm J, Czosnyka M . Assessment of cerebrospinal fluid outflow resistance. Med Biol Eng Comput. 2007; 45(8):719-35. DOI: 10.1007/s11517-007-0199-5. View

Bateman G, Levi C, Schofield P, Wang Y, Lovett E . The venous manifestations of pulse wave encephalopathy: windkessel dysfunction in normal aging and senile dementia. Neuroradiology. 2008; 50(6):491-7. DOI: 10.1007/s00234-008-0374-x. View

Palm W, Saczynski J, van der Grond J, Sigurdsson S, Kjartansson O, Jonsson P . Ventricular dilation: association with gait and cognition. Ann Neurol. 2009; 66(4):485-93. PMC: 4530517. DOI: 10.1002/ana.21739. View

Anile C, PORTNOY H, BRANCH C . Intracranial compliance is time-dependent. Neurosurgery. 1987; 20(3):389-95. DOI: 10.1227/00006123-198703000-00006. View

ORourke M, Hashimoto J . Mechanical factors in arterial aging: a clinical perspective. J Am Coll Cardiol. 2007; 50(1):1-13. DOI: 10.1016/j.jacc.2006.12.050. View

Andersson N, Malm J, Backlund T, Eklund A . Assessment of cerebrospinal fluid outflow conductance using constant-pressure infusion--a method with real time estimation of reliability. Physiol Meas. 2005; 26(6):1137-48. DOI: 10.1088/0967-3334/26/6/022. View

Maset A, Marmarou A, Ward J, Choi S, Lutz H, Brooks D . Pressure-volume index in head injury. J Neurosurg. 1987; 67(6):832-40. DOI: 10.3171/jns.1987.67.6.0832. View

Lenfeldt N, Andersson N, Agren-Wilsson A, Bergenheim A, Koskinen L, Eklund A . Cerebrospinal fluid pulse pressure method: a possible substitute for the examination of B waves. J Neurosurg. 2004; 101(6):944-50. DOI: 10.3171/jns.2004.101.6.0944. View

Sierra C, De La Sierra A, Chamorro A, Larrousse M, Domenech M, Coca A . Cerebral hemodynamics and silent cerebral white matter lesions in middle-aged essential hypertensive patients. Blood Press. 2004; 13(5):304-9. DOI: 10.1080/08037050410024448. View

10.

Shapiro K, Marmarou A, Shulman K . Characterization of clinical CSF dynamics and neural axis compliance using the pressure-volume index: I. The normal pressure-volume index. Ann Neurol. 1980; 7(6):508-14. DOI: 10.1002/ana.410070603. View

11.

Alperin N, Lee S, Loth F, Raksin P, Lichtor T . MR-Intracranial pressure (ICP): a method to measure intracranial elastance and pressure noninvasively by means of MR imaging: baboon and human study. Radiology. 2000; 217(3):877-85. DOI: 10.1148/radiology.217.3.r00dc42877. View

12.

Feugeas M, de Marco G, Peretti I, Godon-Hardy S, Fredy D, Claeys E . Age-related cerebral white matter changes and pulse-wave encephalopathy: observations with three-dimensional MRI. Magn Reson Imaging. 2005; 23(9):929-37. DOI: 10.1016/j.mri.2005.09.002. View

13.

Greitz D . Radiological assessment of hydrocephalus: new theories and implications for therapy. Neurosurg Rev. 2004; 27(3):145-65. DOI: 10.1007/s10143-004-0326-9. View

14.

Marmarou A, Shulman K, LaMorgese J . Compartmental analysis of compliance and outflow resistance of the cerebrospinal fluid system. J Neurosurg. 1975; 43(5):523-34. DOI: 10.3171/jns.1975.43.5.0523. View

15.

Henry-Feugeas M, Roy C, Baron G, Schouman-Claeys E . Leukoaraiosis and pulse-wave encephalopathy: observations with phase-contrast MRI in mild cognitive impairment. J Neuroradiol. 2009; 36(4):212-8. DOI: 10.1016/j.neurad.2009.01.003. View

16.

Marmarou A, Shulman K, Rosende R . A nonlinear analysis of the cerebrospinal fluid system and intracranial pressure dynamics. J Neurosurg. 1978; 48(3):332-44. DOI: 10.3171/jns.1978.48.3.0332. View

17.

Folstein M, Folstein S, McHugh P . "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3):189-98. DOI: 10.1016/0022-3956(75)90026-6. View

18.

Juniewicz H, Kasprowicz M, Czosnyka M, Czosnyka Z, Gizewski S, Dzik M . Analysis of intracranial pressure during and after the infusion test in patients with communicating hydrocephalus. Physiol Meas. 2005; 26(6):1039-48. DOI: 10.1088/0967-3334/26/6/013. View

19.

Lavinio A, Rasulo F, De Peri E, Czosnyka M, Latronico N . The relationship between the intracranial pressure-volume index and cerebral autoregulation. Intensive Care Med. 2008; 35(3):546-9. DOI: 10.1007/s00134-008-1311-5. View

20.

Czosnyka M, Czosnyka Z, Whitfield P, Donovan T, Pickard J . Age dependence of cerebrospinal pressure-volume compensation in patients with hydrocephalus. J Neurosurg. 2001; 94(3):482-6. DOI: 10.3171/jns.2001.94.3.0482. View