INTRACRANIAL DYNAMICS IN DECUBBIT AND BIPEDESTATION: DOES IT CHANGE

SOMETHING MORE THAN THE MEAN INTRACRANIAL PRESSURE?

INTRODUCTION
The repercussion of positional changes in the intracranial pressure (ICP) dynamics in
non-critical patients is barely studied in the literature and it's limited to the variation in
absolute ICP values, without take into account other parameters.
OBJECTIVE
Determining how vary the different parameters that can be extracted from an ICP
monitoring during the change from supine to standing position.
METHODS
Retrospective study of patients undergoing a computerized monitoring of ICP in the
Licuoral Hydrodynamics Unit in whom a registry at least 30 minutes before and after a
postural change from supine to standing was available. Those non-shunted patients
whose nocturnal ICP outline was considered quantitative and qualitatively normal were
included in the analysis. The positional changes were automatically analyzed using the
ICP Digital Tools software, extracting the following parameters: mean PIC, dispersion,
cerebral pulse pressure (PP), systolic ascent coefficient (dPdt), pressure-pulse
correlation (RAP) , partial pressure-pulse regression coefficient (RPPC) and closing
hydrostatic pressure (P0). For the statistical analysis, SPSS 21 for Windows was used,
considering P <0.05 as statistically significant.
RESULTS
Of the 308 ICP records, 217 had monitoring during the positional change. In 31 of the
cases, the night registry was considered normal. During the positional change, mean ICP
decreased from 3.66 ± 3.17 mmHg to -5.62 ± 3.63 mmHg (P <0.0001) and P0 from -1.74
± 13.60 to -15, 83 ± 10.15 mmHg (P <0.0001). However, the dispersion increased from
1.79 ± 0.94 to 2.20 ± 0.98 mmHg (P = 0.008), the PP from 2.88 ± 0.93 to 3.58 ± 1.24
mmHg (P <0.0001) and the dPdt from 15.15 ± 6.64 to 17.79 ± 7.17 mmHg / s (P = 0.006).
No statistically significant changes were detected in the RAP or in the RPPC.
CONCLUSION
Changes in intracranial dynamics during positional changes are not limited to the
decrease of mean ICP. The P0 reduces, and the dispersion of the ICP, the PP and the
dPdt rise significantly.
INTRODUCTION: Differences in the intracranial pressure (ICP) dynamics during
positional changes between different pathological situations are scarcely studied.
OBJECTIVES: To determine how vary the parameters that can be extracted from an ICP
record during the change from decubitus to standing in various pathologies, and
compare them with subjects whose ICP registry was considered normal.
MATERIAL AND METHODS: Retrospective study of patients undergoing an ICP
computerized monitoring in the Licuoral Hydrodynamics Unit in whom a registry at least
30 minutes before and after a postural change from decubitus supine to standing was
available. The 31 subjects with quantitatively and qualitatively normal tracing (control
group) were compared with patients diagnosed with idiopathic normal pressure
hydrocefalus (n = 99), secondary hydrocephalus (n = 28), Chiari malformation (n = 27)
and pseudotumor cerebri ( n = 8). For the statistical analysis, SPSS 21 for Windows was
used, considering P <0.05 as statistically significant.
RESULTS: Regard to the control group, a statistically significant increase in mean PIC,
dispersion, pulse pressure (PP), systolic ascent coefficient (dPdt) and pressure-pulse
correlation coefficient (RAP) was detected in the four pathological groups, in both
positions. During the postural change, the intracranial dynamic pattern was identical
between the iNPH patients and the control group, with decrease in mean PIC and P0,
and increase in PP and dPdt. In the other pathologies, some peculiar behavior was
detected: in secondary hydrocephalus, there was no increase in PP when acquiring the
position of standing, in the Chiari malformation the gradient of PIC and P0 (ΔP0)
between decubitus and standing was significantly reduced, and in the pseudotumor
cerebri there was no increase in PP when acquiring the standing position, and the ΔP0
was also reduced as a consequence of a lower decrease in the standing P0.
CONCLUSIONS: Changes in intracranial dynamics during positional changes are similar
in subjects with normal tracing and patients with iNPH. There are peculiarities during
the postural change in patients with Chiari malformation, pseudotumor cerebri and
secondary hydrocephalus.