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Are intracranial pressure wave amplitudes measurable through lumbar puncture?
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
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2013 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 127, no 4, 233-241 p.Article in journal (Refereed) Published
Abstract [en]

 Objective The aim of this study was to investigate whether pulsations measured in the brain correspond to those measured in lumbar space, and subsequently whether lumbar punctures could replace invasive recordings. Methods In ten patients with normal pressure hydrocephalus, simultaneous recordings of the intracranial pressure (ICP; intraparenchymal) and lumbar pressure (LP; cerebrospinal fluid pressure) were performed. During registration, pressure was altered between resting pressure and 45mmHg using an infusion test. Data were analyzed regarding pulsations (i.e., amplitudes). Also, the pressure sensors were compared in a bench test. Results The correlation between intracranial and lumbar amplitudes was 0.98. At resting pressure, and moderately elevated ICP, intracranial pulse amplitudes exceeded that of lumbar space with about 0.9mmHg. At the highest ICP, the difference changed to 0.2mmHg. The bench test showed that the agreement of sensor readings was good at resting pressure, but reduced at higher amplitudes. Conclusions Compared to intracranial registrations, amplitudes measured through lumbar puncture were slightly attenuated. The bench test showed that differences were not attributable to dissimilarities of the sensor systems. A lumbar pressure amplitude measurement is an alternative to ICP recording, but the thresholds for what should be interpreted as elevated amplitudes need to be adjusted.

Place, publisher, year, edition, pages
2013. Vol. 127, no 4, 233-241 p.
Keyword [en]
intracranial pressure, spinal puncture, cerebrospinal fluid pressure, hydrocephalus, normal pressure, pulse pressure waves
National Category
Neurology
Identifiers
URN: urn:nbn:se:umu:diva-68250DOI: 10.1111/j.1600-0404.2012.01701.xISI: 000316215900004OAI: oai:DiVA.org:umu-68250DiVA: diva2:616787
Available from: 2013-04-18 Created: 2013-04-15 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Measurements in Idiopathic Normal Pressure Hydrocephalus: Computerized neuropsychological test battery and intracranial pulse waves
Open this publication in new window or tab >>Measurements in Idiopathic Normal Pressure Hydrocephalus: Computerized neuropsychological test battery and intracranial pulse waves
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Idiopathic Normal Pressure Hydrocephalus (INPH) is a condition affecting gait, cognition and continence. Radiological examination reveals enlarged ventricles of the brain. A shunt that drains CSF from the ventricles to the abdomen often improves the symptoms. Much research on INPH has been focused on identifying tests that predict the outcome after shunt surgery. As part of this quest, there are attempts to find measurement methods of intracranial parameters that are valid, reliable, tolerable and safe for patients.

Today's technologies for intracranial pressure (ICP) measurement are invasive, often requiring a burr-hole in the skull. Recently, a method for non-invasive ICP measurements was suggested: the Pulsatile Index (PI) calculated from transcranial Doppler data assessed from the middle cerebral artery. In this thesis the relation between PI and ICP was explored in INPH patients during controlled ICP regulation by lumbar infusion. The confidence interval for predicted ICP, based on measured PI was too large for the method to be of clinical utility.

In the quest for better predictive tests for shunt success in INPH, recent studies have shown promising results with criteria based on cardiac related ICP wave amplitudes. The brain ventricular system, and the fluid surrounding the spinal cord are in contact. In this thesis it was shown that ICP waves could be measured via lumbar subarachnoid space, with a slight underestimation.

One of the cardinal symptoms of hydrocephalus is cognitive impairment. Neuropsychological studies have demonstrated cognitive tests that are impaired and improve after shunt surgery in INPH patients. However, there is currently no standardized test battery and different studies use different tests. In response, in this thesis a fully automated computerized neuropsychological test battery was developed. The validity, reliability, responsiveness to improvement after shunt surgery and feasibility for testing INPH patients was demonstrated. It was also demonstrated that INPH patients were impaired in all subtests, compared to healthy elderly. 

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2014. 67 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1689
Keyword
Hydrocephalus, Normal Pressure; Neuropsychological tests; Neuropsychology; Reliability and validity; Software; Dementia; intracranial pressure; spinal puncture; cerebrospinal fluid pressure; pulse pressure waves; Blood flow velocity; Middle cerebral artery; Pulsatility index
National Category
Medical and Health Sciences
Research subject
Neurology
Identifiers
urn:nbn:se:umu:diva-96195 (URN)978-91-7601-155-3 (ISBN)
Public defence
2014-12-05, Sal E04 Unod R1, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2014-11-14 Created: 2014-11-12 Last updated: 2015-10-01Bibliographically approved

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Behrens, AndersLenfeldt, NiklasQvarlander, SaraKoskinen, Lars-OweMalm, JanEklund, Anders

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