Body position and cerebrospinal fluid pressure

Abstract

Lumbar cerebrospinal fluid (CSF) pressure was recorded in 116 adult neurosurgical patients in the lateral and sitting positions. The level of zero CSF pressure while in the sitting position (ZPS) and hydrostatic indifferent point (HIP) for lateral and sitting positions were determined and referred to the craniospinal axis. In control patients ZPS was located mainly at the upper cervical region, and showed nearly the same variation and frequency distribution as CSF pressure in the lateral position when efforts were made to reduce sources of error and there was no orthostatic change in CSF filling pressure. Under these circumstances ZPS may be used as a variable comparable from one subject to another. In control patients the HIP was located between C-6 and T-5. In 25 hydrocephalic patients, shunting resulted in a mean caudal shift of ZPS of 244 mm, and a mean pressure fall of 126 mm H2O in the lateral position. This difference was due to a caudal shift of HIP on shunting. A caudally located ZPS was found in patients with complete cervical subarachnoid block. Prevention and treatment of CSF leakage cranial to HIP is discussed.

The Influence of Body Position on Cerebrospinal Fluid Pressure Gradient and Movement in Cats with Normal and Impaired Craniospinal Communication

“…In sitting subjects (upright position), Masserman [9], Loman [10], Loman et al [11], Von Storch et al [12], O'Connell [13], Magnaes [14], [15] and many others all found fluid pressure to be at the atmospheric pressure level in the upper cervical region or at the level of the foramen magnum. Inside the lumbar region, the pressure is positive and its value corresponds to the distance from the CM to the measuring site in the lumbar region.…”

“…Furthermore, it is known that the change in body position (from horizontal to upright, head up or sitting position) is followed by a transient fall in intracranial pressure (ICP) [14], [15] to the subatmospheric value, and it results in a new pressure gradient along the craniospinal axis. It is generally accepted that this decrease lasts for a very short period of time, and that the ICP remains positive.…”

Cardiovascular Adjustments to Gravitational Stress

“…Extravascular pressure changes with varying body position have been measured in the cerebrospinal fluid compartment (139,216,217) and th e abdominal cavity (284). The extravascular pressure in these systems also changes with gravitational force and modifies the effective vascular pressure, i.e., the transmural pressure.…”

Mechanisms behind postspinal headache and brain stem compression following lumbar dural puncture – a physiological approach

“…1 a and b, respectively. As the cavity is a closed and fairly rigid system, the intradural hydrostatic pressure of normally 9-12 mm Hg (19) is of about the same magnitude in all parts of the closed intradural cavity, and will be only moderately lowered when changing from horizontal to vertical position (23). Thus, the tissue pressure of the brain is higher than that of other organs of the body, in which it is close to the atmospheric pressure (24), and the epidural hydrostatic pressure may even be slightly negative (25).…”