Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Neurocritical Care
Published in: Neurocritical Care 3/2017

Open Access 01-06-2017 | Original Article

Transcranial Doppler Monitoring of Intracranial Pressure Plateau Waves

Authors: Danilo Cardim, Bernhard Schmidt, Chiara Robba, Joseph Donnelly, Corina Puppo, Marek Czosnyka, Peter Smielewski

Published in: Neurocritical Care | Issue 3/2017

Login to get access

Abstract

Background

Transcranial Doppler (TCD) has been used to estimate ICP noninvasively (nICP); however, its accuracy varies depending on different types of intracranial hypertension. Given the high specificity of TCD to detect cerebrovascular events, this study aimed to compare four TCD-based nICP methods during plateau waves of ICP.

Methods

A total of 36 plateau waves were identified in 27 patients (traumatic brain injury) with TCD, ICP, and ABP simultaneous recordings. The nICP methods were based on: (1) interaction between flow velocity (FV) and ABP using a “black-box” mathematical model (nICP_BB); (2) diastolic FV (nICP_FV d ); (3) critical closing pressure (nICP_CrCP), and (4) pulsatility index (nICP_PI). Analyses focused on relative changes in time domain between ICP and noninvasive estimators during plateau waves and the magnitude of changes (∆ between baseline and plateau) in real ICP and its estimators. A ROC analysis for an ICP threshold of 35 mmHg was performed.

Results

In time domain, nICP_PI, nICP_BB, and nICP_CrCP presented similar correlations: 0.80 ± 0.24, 0.78 ± 0.15, and 0.78 ± 0.30, respectively. nICP_FV d presented a weaker correlation (R = 0.62 ± 0.46). Correlations between ∆ICP and ∆nICP were better represented by nICP_CrCP and BB, R = 0.48, 0.44 (p < 0.05), respectively. nICP_FV d and PI presented nonsignificant ∆ correlations. ROC analysis showed moderate to good areas under the curve for all methods: nICP_BB, 0.82; nICP_FV d , 0.77; nICP_CrCP, 0.79; and nICP_PI, 0.81.

Conclusions

Changes of ICP in time domain during plateau waves were replicated by nICP methods with strong correlations. In addition, the methods presented high performance for detection of intracranial hypertension. However, absolute accuracy for noninvasive ICP assessment using TCD is still low and requires further improvement.
Literature
1.
2.
Janny P. La Pression Intracranienne Chez l’Homme. Paris; 1950.
3.
Lundburg N. Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Scand Suppl. 1960;36:1–193.
4.
Rosner MJ, Becker DP. Origin and evolution of plateau waves. Experimental observations and a theoretical model. J Neurosurg. 1984;60:312–24.CrossRefPubMed
5.
Avezaat C. Cerebrospinal fluid pulse pressure and intracranial volume-pressure relationships. J Neurol Neurosurg Psychiatry. 1979;42:687–700.
6.
Hayashi M, Handa Y, Kobayashi H, Kawano H, Ishii H, Hirose S. Plateau-wave phenomenon (I). Correlation between the appearance of plateau waves and CSF circulation in patients with intracranial hypertension. Brain. 1991;114 (Pt 6:2681–91.
7.
Hayashi M, Kobayashi H, Kawano H, Yamamoto S, Maeda T. Cerebral blood flow and ICP patterns in patients with communicating hydrocephalus after aneurysm rupture. J Neurosurg. 1984;61:30–6.CrossRefPubMed
8.
Hayashi M, Ishii H, Handa Y, Kobayashi H, Kawano H, Kabuto M. Role of the medulla oblongata in plateau-wave development in dogs. J Neurosurg. 1987;67:97–101.
9.
Renier D, Sainte-Rose C, Marchac D, Hirsch JF. Intracranial pressure in craniostenosis. J Neurosurg. 1982;57:370–7.CrossRefPubMed
10.
Castellani G, Zweifel C, Kim D-J, Carrera E, Radolovich DK, Smielewski P, et al. Plateau waves in head injured patients requiring neurocritical care. Neurocrit Care. 2009;11:143–50.CrossRefPubMed
11.
Ursino M, Di Giammarco P. A mathematical model of the relationship between cerebral blood volume and intracranial pressure changes: the generation of plateau waves. Ann Biomed Eng. 1991;19:15–42.CrossRefPubMed
12.
Sloan M, Alexandrov A, Tegeler C, Spencer M, Caplan L, Feldmann E, et al. Assessment: transcranial Doppler ultrasonography: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2004;62:1468–81.
13.
Dahl A, Lindegaard KF, Russell D, Nyberg-Hansen R, Rootwelt K, Sorteberg W, et al. A comparison of transcranial Doppler and cerebral blood flow studies to assess cerebral vasoreactivity. Stroke. 1992;23:15–9.CrossRefPubMed
14.
Ibaraki M, Ito H, Shimosegawa E, Toyoshima H, Ishigame K, Takahashi K, et al. Cerebral vascular mean transit time in healthy humans: a comparative study with PET and dynamic susceptibility contrast-enhanced MRI. J Cereb Blood Flow Metab. 2007;27:404–13.
15.
Chan KH, Miller JD, Dearden NM, Andrews PJ, Midgley S. The effect of changes in cerebral perfusion pressure upon middle cerebral artery blood flow velocity and jugular bulb venous oxygen saturation after severe brain injury. J Neurosurg. 1992;77:55–61.CrossRefPubMed
16.
Czosnyka M, Matta BF, Smielewski P, Kirkpatrick PJ, Pickard JD. Cerebral perfusion pressure in head-injured patients: a noninvasive assessment using transcranial Doppler ultrasonography. J Neurosurg. 1998;88:802–8.CrossRefPubMed
17.
Schmidt B, Czosnyka M, Schwarze JJ, Sander D, Gerstner W, Lumenta CB, et al. Evaluation of a method for noninvasive intracranial pressure assessment during infusion studies in patients with hydrocephalus. J Neurosurg. 2000;92:793–800.CrossRefPubMed
18.
Cardim D, Robba C, Bohdanowicz M, Donnelly J, Cabella B, Liu X, et al. Non-invasive monitoring of intracranial pressure using transcranial Doppler ultrasonography: is it possible? Neurocrit Care. 2016;25:473–91.
19.
Cardim D, Czosnyka M, Donnelly J, Robba C, Cabella BCT, Liu X, et al. Assessment of non-invasive ICP during CSF infusion test: an approach with transcranial Doppler. Acta Neurochir (Wien). 2016;158:279–87.
20.
Schmidt B, Czosnyka M, Schwarze JJ, Sander D, Gerstner W, Lumenta CB, et al. Cerebral vasodilatation causing acute intracranial hypertension: a method for noninvasive assessment. J Cereb Blood Flow Metab. 1999;19:990–6.
21.
Schmidt B,  Klingelhoefer J, Schwarze JJ, Sander D, Wittich I. Noninvasive prediction of intracranial pressure curves using transcranial Doppler ultrasonography and blood pressure curves. Stroke. 1997;28:2465–72.CrossRefPubMed
22.
Kasuga Y, Nagai H, Hasegawa Y, Nitta M. Transmission characteristics of pulse waves in the intracranial cavity of dogs. J Neurosurg. 1987;66:907–14.CrossRefPubMed
23.
Marmarelis PMV. Analysis of physiological systems. New York: Plenum Press; 1978.CrossRef
24.
Varsos GV, Kolias AG, Smielewski P, Brady KM, Varsos VG, Hutchinson PJ, et al. A noninvasive estimation of cerebral perfusion pressure using critical closing pressure. J Neurosurg. 2015;11:638–48.CrossRef
25.
Kasprowicz M, Diedler J, Reinhard M, Carrera E, Smielewski P, Budohoski KP, et al. Time constant of the cerebral arterial bed. Acta Neurochir Suppl. 2012;114:17–21.
26.
Kim DJ, Kasprowicz M, Carrera E, Castellani G, Zweifel C, Lavinio A, et al. The monitoring of relative changes in compartmental compliances of brain. Physiol Meas. 2009;30:647–59.
27.
Budohoski KP, Schmidt B, Smielewski P, Kasprowicz M, Plontke R, Pickard JD, et al. Non-invasively estimated ICP pulse amplitude strongly correlates with outcome after TBI. Acta Neurochir Suppl. 2012;114:121–5.
28.
Hosmer D, Lameshow S. Applied logistic regression. New York: Wiley; 1989.
29.
30.
Czosnyka M, Smielewski P, Piechnik S, Schmidt EA, Al-Rawi PG, Kirkpatrick PJ, et al. Hemodynamic characterization of intracranial pressure plateau waves in head-injury patients. J. Neurosurg. 1999;91:11–9.CrossRefPubMed
31.
Cardim D, Robba C, Donnelly J, Bohdanowicz M, Schmidt B, Damian M, et al. Prospective study on non-invasive assessment of ICP in head injured patients: comparison of four methods. J Neurotrauma. 2015;33:792–802.
32.
Koskinen LOD, Olivecrona M. Clinical experience with the intraparenchymal intracranial pressure monitoring Codman microsensor system. Neurosurgery. 2005;56:693–7.CrossRefPubMed
33.
Eide PK, Park E-H, Madsen JR. Arterial blood pressure vs intracranial pressure in normal pressure hydrocephalus. Acta Neurol Scand. 2010;122:262–9.
34.
Zacchetti L, Magnoni S, Di Corte F, Zanier ER, Stocchetti N. Accuracy of intracranial pressure monitoring: systematic review and meta-analysis. Crit Care. 2015;19:420.
35.
Czosnyka M, Smielewski P, Timofeev I, Lavinio A, Guazzo E, Hutchinson P, et al. Intracranial pressure: more than a number. Neurosurg Focus. 2007;22:E10.PubMed
Metadata
Title
Transcranial Doppler Monitoring of Intracranial Pressure Plateau Waves
Authors
Danilo Cardim
Bernhard Schmidt
Chiara Robba
Joseph Donnelly
Corina Puppo
Marek Czosnyka
Peter Smielewski
Publication date
01-06-2017
Publisher
Springer US
Published in
Neurocritical Care / Issue 3/2017
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-016-0356-5

Other articles of this Issue 3/2017

Neurocritical Care 3/2017 Go to the issue

Original Article

Management of External Ventricular Drains After Subarachnoid Hemorrhage: A Multi-Institutional Survey

Original Article

Autophagy Biomarkers Beclin 1 and p62 are Increased in Cerebrospinal Fluid after Traumatic Brain Injury

Review Article

Zika Virus Disease for the Neurointensivist

Original Article

Delayed Deterioration of EEG Background Rhythm Post-cardiac Arrest

Translational Research

Isolated Brain Trauma in Cats Triggers Rapid Onset of Hypovolemia

Original Article

Clinical and Laboratory Characteristics for the Diagnosis of Bacterial Ventriculitis After Aneurysmal Subarachnoid Hemorrhage