Systems analysis of cerebrovascular pressure transmission: an observational study in head-injured patients

Ian R. Piper B.Sc. 1 , J. Douglas Miller M.D., Ph.D., F.R.C.S. 1 , N. Mark Dearden F.F.A.R.C.S. 1 , James R. S. Leggate F.R.C.S. 1 and Ian Robertson F.R.C.S. 1
View More View Less
  • 1 Department of Clinical Neurosciences, University of Edinburgh, Edinburgh, Scotland
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

✓ In an observational study in head-injured patients, cerebrovascular pressure transmission was investigated using a systems analysis approach whereby the blood pressure (BP) waveform was used as a measure of an input stimulus to the cerebrovascular bed (CVB) and the intracranial pressure (ICP) waveform as the response to that stimulus. The transfer function is a measure of how much pressure is transmitted through the CVB at a given frequency and is calculated using Fourier analysis of the pressure waveforms. The transfer function allows quantification of the pressure transmission performance of the CVB, thus providing a basis for comparison between normal and abnormal function.

Fifteen hundred samples of ICP and BP waveforms were collected from 30 head-injured patients via microcomputer. Off-line spectral analysis of the waveform database revealed four main classes of transfer function: those with an overall flat transfer function (curve type 1); those with an elevated low-frequency response (curve type 2); those with an elevated high-frequency response (curve type 3); and those exhibiting both an elevated low- and high-frequency response (curve type 4). Curve types 2 and 4 were most often associated with raised ICP (> 20 mm Hg), whereas curve types 1 and 3 were most often affiliated with ICP less than 15 mm Hg. Studies of this type may provide insight into the pathophysiology of the CVB and ultimately aid in the prediction and treatment of raised ICP.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: J. Douglas Miller, M.D., F.R.C.S., Department of Clinical Neurosciences, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, Scotland.
  • 1.

    Allan MWB, , Gray WM, & Asbury AJ: Measurement of arterial pressure using catheter-transducer systems: improvement using the acudynamic. Br J Anaesth 60:413418, 1988 Allan MWB, Gray WM, Asbury AJ: Measurement of arterial pressure using catheter-transducer systems: improvement using the acudynamic. Br J Anaesth 60:413–418, 1988

    • Search Google Scholar
    • Export Citation
  • 2.

    Avezaat CJJ, , van Eijndhoven JHM, & Wyper DJ: Cerebrospinal fluid pulse pressure and intracranial volume-pressure relationships. J Neurol Neurosurg Psychiatry 42:687700, 1979 Avezaat CJJ, van Eijndhoven JHM, Wyper DJ: Cerebrospinal fluid pulse pressure and intracranial volume-pressure relationships. J Neurol Neurosurg Psychiatry 42:687–700, 1979

    • Search Google Scholar
    • Export Citation
  • 3.

    Bray RS, , Sherwood AM, & Halter JA, et al: Development of a clinical monitoring system by means of ICP waveform analysis, in Miller JD, , Teasdale GM, & Rowan JO, et al (eds): Intracranial Pressure VI. Berlin: Springer-Verlag, 1986, pp 260264 Bray RS, Sherwood AM, Halter JA, et al: Development of a clinical monitoring system by means of ICP waveform analysis, in Miller JD, Teasdale GM, Rowan JO, et al (eds): Intracranial Pressure VI. Berlin: Springer-Verlag, 1986, pp 260–264

    • Search Google Scholar
    • Export Citation
  • 4.

    Cardoso ER, , Rowan JO, & Galbraith S: Analysis of the cerebrospinal fluid pulse wave in intracranial pressure. J Neurosurg 59:817821, 1983 Cardoso ER, Rowan JO, Galbraith S: Analysis of the cerebrospinal fluid pulse wave in intracranial pressure. J Neurosurg 59:817–821, 1983

    • Search Google Scholar
    • Export Citation
  • 5.

    Chopp M, & Portnoy HD: Systems analysis of intracranial pressure. Comparison with volume-pressure test and CSF-pulse amplitude analysis. J Neurosurg 53:516527, 1980 Chopp M, Portnoy HD: Systems analysis of intracranial pressure. Comparison with volume-pressure test and CSF-pulse amplitude analysis. J Neurosurg 53:516–527, 1980

    • Search Google Scholar
    • Export Citation
  • 6.

    Cooley JW, & Tukey JW: An algorithm for the machine calculation of complex Fourier series. Math Comput 19:297301, 1965 Cooley JW, Tukey JW: An algorithm for the machine calculation of complex Fourier series. Math Comput 19:297–301, 1965

    • Search Google Scholar
    • Export Citation
  • 7.

    Dearden NM: Management of raised intracranial pressure after severe head injury. Br J Hosp Med 36:94103, 1986 Dearden NM: Management of raised intracranial pressure after severe head injury. Br J Hosp Med 36:94–103, 1986

    • Search Google Scholar
    • Export Citation
  • 8.

    Gabe IT: Pressure measurement in experimental physiology, in Bergal DA, (ed): Cardiovascular Fluid Dynamics. London: Academic Press, 1972, pp 1150 Gabe IT: Pressure measurement in experimental physiology, in Bergal DA (ed): Cardiovascular Fluid Dynamics. London: Academic Press, 1972, pp 11–50

    • Search Google Scholar
    • Export Citation
  • 9.

    Hanson AT, & Warburg E: The theory for elastic liquid-containing membrane manometers. General part. Acta Physiol Scand 19:306343, 1950 Hanson AT, Warburg E: The theory for elastic liquid-containing membrane manometers. General part. Acta Physiol Scand 19:306–343, 1950

    • Search Google Scholar
    • Export Citation
  • 10.

    Kasuga Y, , Nagai H, & Hasegawa Y: Transmission characteristics of pulse waves in the intracranial cavity of dogs during normal intracranial condition, intracranial hypertension, hypercapnia and hydrocephalus, in Hoff JT, & Betz AL, (eds): Intracranial Pressure VII. Berlin: Springer-Verlag, 1986, pp 196200 Kasuga Y, Nagai H, Hasegawa Y: Transmission characteristics of pulse waves in the intracranial cavity of dogs during normal intracranial condition, intracranial hypertension, hypercapnia and hydrocephalus, in Hoff JT, Betz AL (eds): Intracranial Pressure VII. Berlin: Springer-Verlag, 1989, pp 196–200

    • Search Google Scholar
    • Export Citation
  • 11.

    Kasuga Y, , Nagai H, & Hasegawa Y, et al: Transmission characteristics of pulse waves in the intracranial cavity of dogs. J Neurosurg 66:907914, 1987 Kasuga Y, Nagai H, Hasegawa Y, et al: Transmission characteristics of pulse waves in the intracranial cavity of dogs. J Neurosurg 66:907–914, 1987

    • Search Google Scholar
    • Export Citation
  • 12.

    Marmarelis PZ, & Marmarelis VZ: Analysis of Physiological Systems: The White-Noise Approach. New York: Plenum Press, 1987 Marmarelis PZ, Marmarelis VZ: Analysis of Physiological Systems: The White-Noise Approach. New York: Plenum Press, 1987

    • Search Google Scholar
    • Export Citation
  • 13.

    Nakagawa Y, , Tsuru M, & Yada K: Site and mechanism for compression of the venous system during experimental intracranial hypertension. J Neurosurg 41:427434, 1974 Nakagawa Y, Tsuru M, Yada K: Site and mechanism for compression of the venous system during experimental intracranial hypertension. J Neurosurg 41:427–434, 1974

    • Search Google Scholar
    • Export Citation
  • 14.

    O'Rourke MF, & Taylor MG: Vascular impedance of the femoral bed. Circ Res 18:126139, 1966 O'Rourke MF, Taylor MG: Vascular impedance of the femoral bed. Circ Res 18:126–139, 1966

    • Search Google Scholar
    • Export Citation
  • 15.

    Piper IR, , Dearden NM, & Leggate JRS, et al: Methodology of spectral analysis of the intracranial pressure waveform in a head injury intensive care unit, in Hoff JT, & Betz AL, (eds): Intracranial Pressure VII. Berlin: Springer-Verlag, 1986, pp 668677 Piper IR, Dearden NM, Leggate JRS, et al: Methodology of spectral analysis of the intracranial pressure waveform in a head injury intensive care unit, in Hoff JT, Betz AL (eds): Intracranial Pressure VII. Berlin: Springer-Verlag, 1989, pp 668–677

    • Search Google Scholar
    • Export Citation
  • 16.

    Piper IR, , Dearden NM, & Miller JD: Can waveform analysis of ICP separate vascular from non-vascular causes of intracranial hypertension?, in Hoff JT, & Betz AL, (eds): Intracranial Pressure VII. Berlin: Springer-Verlag, 1986, pp 157163 Piper IR, Dearden NM, Miller JD: Can waveform analysis of ICP separate vascular from non-vascular causes of intracranial hypertension?, in Hoff JT, Betz AL (eds): Intracranial Pressure VII. Berlin: Springer-Verlag, 1989, pp 157–163

    • Search Google Scholar
    • Export Citation
  • 17.

    Piper IR, , Dearden NM, & Miller JD, et al: A microcomputer based pressure waveform analysis system. J Physiol (Lond) 420:2P, 1990 (Abstract) Piper IR, Dearden NM, Miller JD, et al: A microcomputer based pressure waveform analysis system. J Physiol (Lond) 420:2P, 1990 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 18.

    Portnoy HD, , Branch C, & Chopp M: The CSF pulse wave in hydrocephalus. Childs Nerv Syst 1:248254, 1985 Portnoy HD, Branch C, Chopp M: The CSF pulse wave in hydrocephalus. Childs Nerv Syst 1:248–254, 1985

    • Search Google Scholar
    • Export Citation
  • 19.

    Portnoy HD, & Chopp M: Cerebrospinal fluid pulse wave form analysis during hypercapnia and hypoxia. Neurosurgery 9:1427, 1981 Portnoy HD, Chopp M: Cerebrospinal fluid pulse wave form analysis during hypercapnia and hypoxia. Neurosurgery 9:14–27, 1981

    • Search Google Scholar
    • Export Citation
  • 20.

    Portnoy HD, , Chopp M, & Branch C: Hydraulic model of myogenic autoregulation and the cerebrovascular bed: the effects of altering systemic arterial pressure. Neurosurgery 13:482498, 1983 Portnoy HD, Chopp M, Branch C: Hydraulic model of myogenic autoregulation and the cerebrovascular bed: the effects of altering systemic arterial pressure. Neurosurgery 13:482–498, 1983

    • Search Google Scholar
    • Export Citation
  • 21.

    Portnoy HD, , Chopp M, & Branch C, et al: Cerebrospinal fluid pulse waveform as an indicator of cerebral autoregulation. J Neurosurg 56:666678, 1982 Portnoy HD, Chopp M, Branch C, et al: Cerebrospinal fluid pulse waveform as an indicator of cerebral autoregulation. J Neurosurg 56:666–678, 1982

    • Search Google Scholar
    • Export Citation
  • 22.

    Press WH, , Flannery BP, & Teukolsky SA, et al: Numerical Recipes. The Art of Scientific Computing. Cambridge: Cambridge University Press, 1987 Press WH, Flannery BP, Teukolsky SA, et al: Numerical Recipes. The Art of Scientific Computing. Cambridge: Cambridge University Press, 1987

    • Search Google Scholar
    • Export Citation
  • 23.

    Robertson CS, , Narayan RK, & Contant CF, et al: Clinical experience with a continuous monitor of intracranial compliance. J Neurosurg 71:673680, 1989 Robertson CS, Narayan RK, Contant CF, et al: Clinical experience with a continuous monitor of intracranial compliance. J Neurosurg 71:673–680, 1989

    • Search Google Scholar
    • Export Citation
  • 24.

    Snedecor GW, & Cochran WG: Statistical Methods, ed 8. Ames, Iowa: Iowa State University Press, 1982 Snedecor GW, Cochran WG: Statistical Methods, ed 8.Ames, Iowa: Iowa State University Press, 1982

    • Search Google Scholar
    • Export Citation
  • 25.

    Stremler FG: Introduction to Communication Systems. London: Addison Wesley Press, 1987 Stremler FG: Introduction to Communication Systems. London: Addison Wesley Press, 1987

    • Search Google Scholar
    • Export Citation
  • 26.

    Takizawa H, , Gabra-Sanders T, & Miller JD: Changes in the cerebrospinal fluid pulse wave spectrum associated with raised intracranial pressure. Neurosurgery 20:355361, 1987 Takizawa H, Gabra-Sanders T, Miller JD: Changes in the cerebrospinal fluid pulse wave spectrum associated with raised intracranial pressure. Neurosurgery 20:355–361, 1987

    • Search Google Scholar
    • Export Citation
  • 27.

    Takizawa H, , Gabra-Sanders T, & Miller JD: Spectral analysis of the CSF pulse wave at different locations in the craniospinal axis. J Neurol Neurosurg Psychiatry 49:11351141, 1986 Takizawa H, Gabra-Sanders T, Miller JD: Spectral analysis of the CSF pulse wave at different locations in the craniospinal axis. J Neurol Neurosurg Psychiatry 49:1135–1141, 1986

    • Search Google Scholar
    • Export Citation
  • 28.

    Taylor MG: An introduction to some recent developments in arterial haemodynamics. Aust Ann Med 15:7186, 1966 Taylor MG: An introduction to some recent developments in arterial haemodynamics. Aust Ann Med 15:71–86, 1966

    • Search Google Scholar
    • Export Citation
  • 29.

    Yada K, , Nakagawa Y, & Tsuru M: Circulatory disturbance of the venous system during experimental intracranial hypertension. J Neurosurg 39:723729, 1973 Yada K, Nakagawa Y, Tsuru M: Circulatory disturbance of the venous system during experimental intracranial hypertension. J Neurosurg 39:723–729, 1973

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 349 130 3
Full Text Views 151 4 0
PDF Downloads 69 4 0
EPUB Downloads 0 0 0