The impact of raised intracranial pressure on cerebral venous hemodynamics: a prospective venous transcranial Doppler ultrasonography study

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Object. The effect of increased intracranial pressure (ICP) on cerebral venous blood flow has been the subject of very few clinical and experimental studies. The authors assessed the usefulness of venous transcranial Doppler (TCD) ultrasonography as a noninvasive monitoring tool for predicting raised ICP.

Methods. Serial venous TCD studies of the basal vein of Rosenthal and the straight sinus (SS) were prospectively performed in 30 control volunteers and 25 patients with raised ICP. Correlations with ICP data were calculated using a multivariate regression model. Venous blood flow velocities (BFVs) in the basal vein of Rosenthal showed, within a certain range, a linear relationship between mean ICP and maximal venous BFV (r = 0.645; p < 0.002). Moreover, a linear relationship was found for maximal venous BFVs in the SS and mean ICP (r = 0.928; p < 0.0003).

Conclusions. Venous TCD studies may provide an additional noninvasive monitoring tool for raised ICP and give further insights into the cerebral venous hemodynamics present during raised ICP.

Article Information

Address reprint requests to: Benedikt G. H. Schoser, M.D., Department of Neurology, University Hospital Hamburg—Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany. email: schoser@uke.uni-hamburg.de.

© AANS, except where prohibited by US copyright law.

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Figures

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    Tracings showing serial venous TCD recordings of the basal vein of Rosenthal in a control volunteer (A) and in patients with raised ICP (B–F). A: Heart rate 74 beats/minute, maximal BFV 16 cm/second (background is posterior cerebral artery). B: Heart rate 102 beats/minute, ICP 9 mm Hg, maximal BFV 9 cm/second. C: Valsalva maneuver: ICP 19 mm Hg, heart rate 90 beats/minute, maximal BFV 20 cm/second. D: Heart rate 90 beats/minute, ICP 24 mm Hg, maximal BFV 22 cm/second. E: Heart rate 98 beats/minute, ICP 36 mm Hg, maximal BFV 34 cm/second. F: Heart rate 82 beats/minute, ICP 45 mm Hg, maximal BFV 42 cm/second.

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    Tracings showing serial venous TCD recordings of the SS. A: Heart rate 84 beats/minute, ICP 15 mm Hg, maximal BFV 24 cm/second. B: Heart rate 90 beats/minute, ICP 25 mm Hg, maximal BFV 30 cm/second. C: Heart rate 80 beats/minute, ICP 35 mm Hg, maximal BFV 48 cm/second. Final portion of recording: Valsalva maneuver.

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    Scatterplots showing the relationship between ICP and venous TCD values of the basal vein of Rosenthal. CI = confidence interval.

  • View in gallery

    Scatterplots showing the relationship between ICP and venous TCD values of the SS.

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