Pulsatility in CSF dynamics : pathophysiology of idiopathic normal pressure hydrocephalus
Background: It is suggested that disturbed CSF dynamics are involved in the pathophysiology of idiopathic normal pressure hydrocephalus (INPH). The pulsatility curve describes the relationship between intracranial pressure (ICP) and the amplitude of cardiac related ICP pulsations. The position of ba...
Published in: | Journal of Neurology, Neurosurgery & Psychiatry |
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ftumeauniv:oai:DiVA.org:umu-78953 2023-10-09T21:54:37+02:00 Pulsatility in CSF dynamics : pathophysiology of idiopathic normal pressure hydrocephalus Qvarlander, Sara Lundkvist, Bo Koskinen, Lars-Owe D Malm, Jan Eklund, Anders 2013 application/pdf http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-78953 https://doi.org/10.1136/jnnp-2012-302924 eng eng Radiofysik Centrum för medicinsk teknik och fysik (CMTF) Klinisk neurovetenskap BMJ Publishing Group Journal of Neurology, Neurosurgery and Psychiatry, 0022-3050, 2013, 84:7, s. 735-741 orcid:0000-0003-3528-8502 orcid:0000-0001-6451-1940 orcid:0000-0002-2031-722X http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-78953 doi:10.1136/jnnp-2012-302924 ISI:000320108200010 Scopus 2-s2.0-84878753397 info:eu-repo/semantics/openAccess Radiology Nuclear Medicine and Medical Imaging Radiologi och bildbehandling Article in journal info:eu-repo/semantics/article text 2013 ftumeauniv https://doi.org/10.1136/jnnp-2012-302924 2023-09-22T13:57:25Z Background: It is suggested that disturbed CSF dynamics are involved in the pathophysiology of idiopathic normal pressure hydrocephalus (INPH). The pulsatility curve describes the relationship between intracranial pressure (ICP) and the amplitude of cardiac related ICP pulsations. The position of baseline ICP on the curve provides information about the physiological state of the CSF dynamic system. The objective of the study was to investigate if shunt surgery modifies the pulsatility curve and the baseline position on the curve, and how this relates to gait improvement in INPH. Methods: 51 INPH patients were investigated with lumbar CSF dynamic investigations preoperatively and 5 months after shunt surgery. During the investigation, ICP was measured at baseline, and then a CSF sample was removed, resulting in pressure reduction. After this, ICP was regulated with an automated infusion protocol, with a maximum increase of 24 mm Hg above baseline. The pulsatility curve was thus determined in a wide range of ICP values. Gait improvement was defined as a gait speed increase >= 0.1 m/s. Results: The pulsatility curve was unaltered by shunting. Baseline ICP and amplitude were reduced (-3.0 +/- 2.9 mm Hg; -1.1 +/- 1.5 mm Hg; p < 0.05, n = 51). Amplitude reduction was larger for gait improvers (-1.2 +/- 1.6 mm Hg, n = 42) than non-improvers (-0.2 +/- 0.5 mm Hg, n = 9) (p < 0.05) although mean ICP reduction did not differ. Conclusions: The pulsatility curve was not modified by shunt surgery, while the baseline position was shifted along the curve. Observed differences between gait improvers and non-improvers support cardiac related ICP pulsations as a component of INPH pathophysiology. This project was supported by the Swedish Research Council, VINNOVA, and the Swedish Foundation for Strategic Research through their common initiative: 'Biomedical engineering for improved health' grant No VR3011-2006-7551; and by the European Union through ERDF: Objective 2, Northern Sweden grant No 158715-CMTF. Article in Journal/Newspaper Northern Sweden Umeå University: Publications (DiVA) Journal of Neurology, Neurosurgery & Psychiatry 84 7 735 741 |
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Open Polar |
collection |
Umeå University: Publications (DiVA) |
op_collection_id |
ftumeauniv |
language |
English |
topic |
Radiology Nuclear Medicine and Medical Imaging Radiologi och bildbehandling |
spellingShingle |
Radiology Nuclear Medicine and Medical Imaging Radiologi och bildbehandling Qvarlander, Sara Lundkvist, Bo Koskinen, Lars-Owe D Malm, Jan Eklund, Anders Pulsatility in CSF dynamics : pathophysiology of idiopathic normal pressure hydrocephalus |
topic_facet |
Radiology Nuclear Medicine and Medical Imaging Radiologi och bildbehandling |
description |
Background: It is suggested that disturbed CSF dynamics are involved in the pathophysiology of idiopathic normal pressure hydrocephalus (INPH). The pulsatility curve describes the relationship between intracranial pressure (ICP) and the amplitude of cardiac related ICP pulsations. The position of baseline ICP on the curve provides information about the physiological state of the CSF dynamic system. The objective of the study was to investigate if shunt surgery modifies the pulsatility curve and the baseline position on the curve, and how this relates to gait improvement in INPH. Methods: 51 INPH patients were investigated with lumbar CSF dynamic investigations preoperatively and 5 months after shunt surgery. During the investigation, ICP was measured at baseline, and then a CSF sample was removed, resulting in pressure reduction. After this, ICP was regulated with an automated infusion protocol, with a maximum increase of 24 mm Hg above baseline. The pulsatility curve was thus determined in a wide range of ICP values. Gait improvement was defined as a gait speed increase >= 0.1 m/s. Results: The pulsatility curve was unaltered by shunting. Baseline ICP and amplitude were reduced (-3.0 +/- 2.9 mm Hg; -1.1 +/- 1.5 mm Hg; p < 0.05, n = 51). Amplitude reduction was larger for gait improvers (-1.2 +/- 1.6 mm Hg, n = 42) than non-improvers (-0.2 +/- 0.5 mm Hg, n = 9) (p < 0.05) although mean ICP reduction did not differ. Conclusions: The pulsatility curve was not modified by shunt surgery, while the baseline position was shifted along the curve. Observed differences between gait improvers and non-improvers support cardiac related ICP pulsations as a component of INPH pathophysiology. This project was supported by the Swedish Research Council, VINNOVA, and the Swedish Foundation for Strategic Research through their common initiative: 'Biomedical engineering for improved health' grant No VR3011-2006-7551; and by the European Union through ERDF: Objective 2, Northern Sweden grant No 158715-CMTF. |
format |
Article in Journal/Newspaper |
author |
Qvarlander, Sara Lundkvist, Bo Koskinen, Lars-Owe D Malm, Jan Eklund, Anders |
author_facet |
Qvarlander, Sara Lundkvist, Bo Koskinen, Lars-Owe D Malm, Jan Eklund, Anders |
author_sort |
Qvarlander, Sara |
title |
Pulsatility in CSF dynamics : pathophysiology of idiopathic normal pressure hydrocephalus |
title_short |
Pulsatility in CSF dynamics : pathophysiology of idiopathic normal pressure hydrocephalus |
title_full |
Pulsatility in CSF dynamics : pathophysiology of idiopathic normal pressure hydrocephalus |
title_fullStr |
Pulsatility in CSF dynamics : pathophysiology of idiopathic normal pressure hydrocephalus |
title_full_unstemmed |
Pulsatility in CSF dynamics : pathophysiology of idiopathic normal pressure hydrocephalus |
title_sort |
pulsatility in csf dynamics : pathophysiology of idiopathic normal pressure hydrocephalus |
publisher |
Radiofysik |
publishDate |
2013 |
url |
http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-78953 https://doi.org/10.1136/jnnp-2012-302924 |
genre |
Northern Sweden |
genre_facet |
Northern Sweden |
op_relation |
Journal of Neurology, Neurosurgery and Psychiatry, 0022-3050, 2013, 84:7, s. 735-741 orcid:0000-0003-3528-8502 orcid:0000-0001-6451-1940 orcid:0000-0002-2031-722X http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-78953 doi:10.1136/jnnp-2012-302924 ISI:000320108200010 Scopus 2-s2.0-84878753397 |
op_rights |
info:eu-repo/semantics/openAccess |
op_doi |
https://doi.org/10.1136/jnnp-2012-302924 |
container_title |
Journal of Neurology, Neurosurgery & Psychiatry |
container_volume |
84 |
container_issue |
7 |
container_start_page |
735 |
op_container_end_page |
741 |
_version_ |
1779318260287668224 |