Effect of position on intracranial pressure and compliance: a cross-sectional study including 101 patients

Linda D’Antona MD, MBBS1,2, Claudia Louise Craven MSc, MRCS1, Fion Bremner PhD, FRCOphth2,3, Manjit Singh Matharu PhD, FRCP4, Lewis Thorne FRCS1, Laurence Dale Watkins MD, FRCS1, and Ahmed Kassem Toma MD, FRCS1,2
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  • 1 Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square;
  • | 2 UCL Queen Square Institute of Neurology;
  • | 3 Department of Neuro-Ophthalmology, The National Hospital for Neurology and Neurosurgery; and
  • | 4 Headache and Facial Pain Group, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
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OBJECTIVE

A better understanding of the effect of position on intracranial pressure (ICP) and compliance is important for the development of treatment strategies that can restore normal cerebrospinal fluid (CSF) dynamics. There is limited knowledge on the effect of position on intracranial compliance. In this cross-sectional study the authors tested the association of pulse amplitude (PA) with position and the day/night cycle. Additionally, they describe the postural ICP and PA changes of patients with “normal” ICP dynamics.

METHODS

This single-center retrospective study included patients with suspected and/or confirmed CSF dynamics abnormalities who had been examined with elective 24-hour ICP monitoring between October 2017 and September 2019. Patients had been enrolled in a short exercise battery including four positions: supine, lumbar puncture position in the left lateral decubitus position, sitting, and standing. Each position was maintained for 2 minutes, and mean ICP and PA were calculated for each position. The 24-hour day and night median ICP and PA data were also collected. Linear regression models were used to test the correlation of PA with position and day/night cycle. All linear regressions were corrected for confounders. The postural ICP monitoring results of patients without obvious ICP dynamics abnormality were summarized.

RESULTS

One hundred one patients (24 males and 77 females) with a mean age of 39 ± 13years (mean ± standard deviation) were included in the study. The adjusted linear regression models demonstrated a significant association of ICP with position and day/night cycle, with upright (sitting and standing) and day ICP values lower than supine and night ICP values. The adjusted linear regression model was also significant for the association of PA with position and day/night cycle, with upright and day PA values higher than supine and night PA results. These associations were confirmed for patients with and without shunts. Patients without clear ICP dynamics abnormality had tighter control of their postural ICP changes than the other patients; however, the difference among groups was not statistically significant.

CONCLUSIONS

This is the largest study investigating the effect of postural changes on intracranial compliance. The results of this study suggest that PA, as well as ICP, is significantly associated with posture, increasing in upright positions compared to that while supine. Further studies will be needed to investigate the mechanism behind this association.

ABBREVIATIONS

CM-I = Chiari malformation type I; CSF = cerebrospinal fluid; ICP = intracranial pressure; IIH = idiopathic intracranial hypertension; NHNN = The National Hospital for Neurology and Neurosurgery; NPH = normal pressure hydrocephalus; PA = pulse amplitude.

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