Cerebral blood-flow velocity and intermittent intracranial pressure elevation during sleep in hydrocephalic children.
The clinical importance of intermittent intracranial pressure (ICP) elevations during sleep in hydrocephalic children is unclear. Eight studies of continuous ICP monitoring with simultaneous cerebral blood-flow velocity (CBFV) measurements were recorded during sleep in seven hydrocephalic children aged between one and 10 years. ICP was measured directly through a frontal reservoir. There were two main patterns of CBFV change in response to raised ICP: a progressive decrease in mean flow velocity and increase in resistance index, suggesting impaired haemodynamic compensation to ICP elevation due to reduced circulatory reserve in patients with limited intracranial compliance; and an increase in mean flow velocity with raised ICP, suggesting that appropriate haemodynamic compensation with increased blood-flow can occur to maintain adequate cerebral perfusion in those with sufficient circulatory reserve. Simultaneous CBFV and ICP measurements may help to identify those with reduced circulatory reserve who are at greater risk of ischaemic insult from episodic increases in ICP.
Goh
D
D
Department of Paediatric Neurology, Royal Hospital for Sick Children, Edinburgh.
Minns
R A
RA
Pye
S D
SD
Steers
A J
AJ
D001783:Blood Flow Velocity / Q000502:physiology; D001921:Brain / Q000098:blood supply*; D002557:Cerebrospinal Fluid Shunts; D002648:Child; D002675:Child, Preschool; D004453:Echoencephalography; D005260:Female; D006706:Homeostasis / Q000502:physiology; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D007223:Infant; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D012894:Sleep Stages / Q000502:physiology*