Abstract
In patients with subarachnoid haemorrhage, pulsatile intracranial pressure (ICP) is more strongly associated with adverse events than mean ICP. Furthermore, patients with idiopathic normal-pressure hydrocephalus (iNPH), and pulsatile ICP of 5 mmHg or more, gain more benefit from cerebrospinal fluid (CSF) shunting than those whose pulsatile ICP is lower than 5 mmHg.
Our study aims to investigate the morphological relationship between ICP pulsations, aortic pressure pulsations and radial artery pulsations. Central aortic pulse pressure has been known to be the best predictor of adverse cardiac events, whereas radial artery pulse pressure is generally measured and displayed in intensive care environments.
We studied 10 patients with iNPH, and their ICP and aortic and radial pressures were digitised, ensemble-averaged and compared in the time and frequency domains. The ICP wave contour was quite different to the radial pressure waveform. By contrast, the ICP waveform was similar to the aortic pressure wave contour. The ICP amplitude averaged <10 % of aortic pulse pressure. In the frequency domain, the relative amplitude of the first three harmonics was similar for the ICP and aortic pressure. Hence, monitoring central aortic pressure through derivation from the radial pressure wave is superior to measurement of radial pressure alone.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, Christiaens T, Cifkova R, DeBacker G, Dominiczak A, Galderisi M, Grobbee DE, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Ruilope LM, Schmieder RE, Sirnes PA, Sleight P, Viigimaa M, Waeber B, Zannad F (2013) 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 31:1281–357
Eide PK, Sorteberg A, Bentsen G, Marthinsen PB, Stubhaug A, Sorteberg W (2012) Pressure-derived versus pressure wave amplitude-derived indices of cerebrovascular pressure reactivity in relation to early clinical state and 12-month outcome following aneurysmal subarachnoid hemorrhage. J Neurosurg 116:961–71
Nichols WW, O’Rourke MF, Vlachopoulos C (2011) McDonald’s blood flow in arteries, 6th edn. Arnold Hodder, London
Eide PK, Park EH, Madsen JR (2010) Arterial blood pressure vs intracranial pressure in normal pressure hydrocephalus. Acta Neurol Scand 122:262–9
Hirata K, Yaginuma T, O’Rourke MF, Kawakami M (2006) Age-related change in the carotid artery flow and pressure pulses implications to cerebral microvascular disease. Stroke 37:2552–6
Hirata K, O’Rourke MF, Momomura S (2007) Favourable effect of sublingual nitrate on carotid flow and pressure augmentation index. J Clin Hypertens 9(Suppl A):A29
Hirata K, O’Rourke MF, Momomura S (2008) Flow augmentation index as a major risk factor for silent lacunar infarction. J Hypertens 26(Suppl 1):S395
Pauca AL, O’Rourke MF, Kon ND (2001) Prospective evaluation of a method for estimating ascending aortic pressure from the radial artery pressure waveform. Hypertension 38:932–7
Pauca AL, Kon ND, O’Rourke MF (2005) Benefits of nitroglycerine on arterial stiffness is directly due to effects on peripheral arteries. Heart 91:1428–32
Conflict of Interest Statement
Dr O’Rourke is a founding director of AtCor Medical P/L, manufacturer of the pulse wave analysis system, SphygmoCor, and of Aortic Wrap P/L, the developer of methods to reduce aortic stiffness, and is consultant to Novartis and Merck. Other authors have nothing to disclose.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Kim, M.O., Eide, P.K., O’Rourke, M.F., Adji, A., Avolio, A.P. (2016). Intracranial Pressure Waveforms are More Closely Related to Central Aortic than Radial Pressure Waveforms: Implications for Pathophysiology and Therapy. In: Ang, BT. (eds) Intracranial Pressure and Brain Monitoring XV. Acta Neurochirurgica Supplement, vol 122. Springer, Cham. https://doi.org/10.1007/978-3-319-22533-3_12
Download citation
DOI: https://doi.org/10.1007/978-3-319-22533-3_12
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-22532-6
Online ISBN: 978-3-319-22533-3
eBook Packages: MedicineMedicine (R0)