Lalou, A. D. | Search bioRxiv

bioRxiv2018

Validation of Davson’s equation in patients suffering from idiopathic Normal Pressure Hydrocephalus

IntroductionThe so called Davsons equation relates baseline intracranial pressure (ICP) to resistance to cerebrospinal fluid outflow (Rout), formation of cerebrospinal fluid (If) and sagittal sinus pressure (PSS) There is a controversy over whether this fundamental equation is applicable in patients with normal pressure hydrocephalus (NPH). We investigated the relationship between Rout and ICP and also other compensatory, clinical and demographic parameters in NPH patients.\n\nMethodWe carried out a retrospective study of 229 patients with primary NPH who had undergone constant-rate infusion studies in our hospital. Data was recorded and processed using ICM+ software. Relationships between variables were sought by calculating Pearson product correlation coefficients and p values.\n\nResultsWe found a significant, albeit weak, relationship between ICP and Rout (R=0.17, p=0.0049), Rout and peak-to-peak amplitude of ICP (AMP) (R=0.27, p=3.577e-05) and Rout and age (R=0.16, p=0.01306).\n\nConclusionsThe relationship found between ICP and Rout provides indirect evidence to support disturbed Cerebrospinal fluid circulation as a key factor in disturbed CSF dynamics in NPH. Weak correlation may indicate that other factors: variable Pss and formation of CSF outflow contribute heavily to linear model expressed by Davsons equation.

neuroscience↗

bioRxiv2017

Cerebral Autoregulation, CSF outflow resistance and outcome following CSF diversion in Normal Pressure Hydrocephalus.

IntroductionNormal pressure hydrocephalus (NPH) is not simply the result of a disturbance in cerebrospinal fluid (CSF) circulation, but often includes cardiovascular comorbidity and abnormalities within the cerebral mantle. In this study, we have examined the relationship between the global autoregulation pressure reactivity index (PRx), the profile of disturbed CSF circulation and pressure-volume compensation, and their possible effects on outcome after surgery.\n\nMaterials and methodsWe studied a cohort of 131 patients, investigated for possible NPH. Parameters describing CSF compensation and circulation were calculated during the cerebrospinal fluid (CSF) infusion test and PRx was calculated from CSF pressure and arterial pressure recordings. A simple scale was used to mark the patients outcome 6 months after surgery (improvement, temporary improvement, and no improvement).\n\nResultsPRx was negatively correlated with Rout (R=-0.18; p=0.044); patients with normal CSF circulation tended to have worse autoregulation. The correlation for patients who were surgically-managed (N=83) was: R=-0.28; p=0.03, and stronger in patients who improved after surgery (N=64; R=-0.36; p=0.03). In patients who did not improve, the correlation was not significantly different from zero (N= 19; R=0.17; p=0.15). There was a trend towards higher values for PRx in non-responders than in responders (PRx =0.16+/- 0.04 vs 0.09 +/-0.02 respectively; p=0.061), associated with higher MAP values (107.2+/-8.2 in non-responders vs 89.5+/-3.5 in responders; p=0.195). The product of MAP* (1+PRx), proposed as a measure of combined arterial hypertension and deranged autoregulation, showed a significant association with outcome (greater value in non-responders; p=0.013).\n\nConclusionAutoregulation proves to associate with cerebrospinal fluid circulation, and appears strongest in shunt responders. Outcome following CSF diversion is possibly most favorable when CSF outflow resistance is increased and global cerebral autoregulation is intact, in combination with arterial normotension.

neuroscience↗