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Cerebral critical closing pressure in hydrocephalus patients undertaking infusion tests.
Varsos, Georgios V,Czosnyka, Marek,Smielewski, Peter,Garnett, Matthew R,Liu, Xiuyun,Kim, Dong-Joo,Donnelly, Joseph,Adams, Hadie,Pickard, John D,Czosnyka, Zofia Butterworths [etc.] 2015 Neurological research Vol.37 No.8
<P>Links between cerebrospinal fluid (CSF) compensation and cerebral blood flow (CBF) have been studied in many clinical scenarios. In hydrocephalus, disturbed CSF circulation seems to be a primary problem, having been linked to CBF disturbances, particularly in white matter close to surface of dilated ventricles. We studied possible correlations between cerebral haemodynamic indices using transcranial Doppler (TCD) ultrasonography and CSF compensatory dynamics assessed during infusion tests.</P>
Cerebral Vasospasm Affects Arterial Critical Closing Pressure
Varsos, Georgios V,Budohoski, Karol P,Czosnyka, Marek,Kolias, Angelos G,Nasr, Nathalie,Donnelly, Joseph,Liu, Xiuyun,Kim, Dong-Joo,Hutchinson, Peter J,Kirkpatrick, Peter J,Varsos, Vassilis G,Smielewski SAGE Publications 2015 Journal of cerebral blood flow and metabolism Vol.35 No.2
<P> The effect of cerebral vasospasm (CVS) after aneurysmal subarachnoid hemorrhage (SAH) on critical closing pressure (CrCP) has not been fully delineated. Using cerebral impedance methodology, we sought to assess the behavior of CrCP during CVS. As CrCP expresses the sum of intracranial pressure (ICP) and vascular wall tension, we also explored its role in reflecting changes in vascular tone occurring in small vessels distal to spasm. This retrospective analysis was performed using recordings from 52 patients, diagnosed with CVS through transcranial Doppler measurements. Critical closing pressure was calculated noninvasively using arterial blood pressure and blood flow velocity. Outcome was assessed at both discharge and 3 months after ictus with the Glasgow Outcome Scale. The onset of CVS caused significant decreases in CrCP ( P=0.025), without any observed significant changes in ICP ( P=0.134). Vasospasm induced asymmetry, with CrCP ipsilateral to CVS becoming significantly lower than contralateral ( P=0.025). Unfavorable outcomes were associated with a significantly lower CrCP after the onset of CVS (discharge: P=0.014; 3 months after SAH: P=0.020). Critical closing pressure is reduced in the presence of CVS in both temporal and spatial assessments. As ICP remained unchanged during CVS, reduced CrCP most probably reflects a lower wall tension in dilated small vessels distal to spasm. </P>