Changes in Cerebral Partial Oxygen Pressure and Cerebrovascular Reactivity During Intracranial Pressure Plateau Waves

Lang, E; Kasprowicz, Magdalena; Smielewski, Peter; Pickard, John D.; Czosnyka, Marek

doi:10.1007/s12028-014-0074-9

Cited by 14 publications

(7 citation statements)

References 54 publications

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“…2, Table 2). This confirms previous investigations of autoregulation during short-term increases in ICP (plateau waves) [13,14] and is consistent with a recent large between patient analysis that found a significant correlation between mean ICP over the whole monitoring period and mean PRx [15]. In contrast to these studies, however, the current analysis observed changes within patients and over periods of time that are substantially longer than the calculation window for PRx.…”

Section: Autoregulation Parameterssupporting

confidence: 92%

Observations on the Cerebral Effects of Refractory Intracranial Hypertension After Severe Traumatic Brain Injury

et al. 2019

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Background: Raised intracranial pressure (ICP) is a prominent cause of morbidity and mortality after severe traumatic brain injury (TBI). However, in the clinical setting, little is known about the cerebral physiological response to severe and prolonged increases in ICP. Methods: Thirty-three severe TBI patients from a single center who developed severe refractory intracranial hypertension (ICP > 40 mm Hg for longer than 1 h) with ICP, arterial blood pressure, and brain tissue oxygenation (P BT O 2) monitoring (subcohort, n = 9) were selected for retrospective review. Secondary parameters reflecting autoregulation (including pressure reactivity index-PRx, which was available in 24 cases), cerebrospinal compensatory reserve (RAP), and ICP pulse amplitude were calculated. Results: PRx deteriorated from 0.06 ± 0.26 a.u. at baseline levels of ICP to 0.57 ± 0.24 a.u. (p < 0.0001) at high levels of ICP (> 50 mm Hg). In 4 cases, PRx was impaired (> 0.25 a.u.) before ICP was raised above 25 mm Hg. Concurrently, P BT O 2 decreased from 27.3 ± 7.32 mm Hg at baseline ICP to 12.68 ± 7.09 mm Hg at high levels of ICP (p < 0.001). The pulse amplitude of the ICP waveform increased with increasing ICP but showed an 'upper breakpoint'-whereby further increases in ICP lead to decreases in pulse amplitude-in 6 out of the 33 patients. Discussion: Severe intracranial hypertension after TBI leads to decreased brain oxygenation, impaired pressure reactivity, and changes in the pulse amplitude of ICP. Impaired pressure reactivity may denote increased risk of developing refractory intracranial hypertension in some patients.

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Section: Autoregulation Parameterssupporting

confidence: 92%

Observations on the Cerebral Effects of Refractory Intracranial Hypertension After Severe Traumatic Brain Injury

et al. 2019

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“…9 Cerebral vascular dysregulation has been demonstrated in multimodal monitoring of patients with traumatic brain injury at the peak of plateau waves. 5 Specifically, EEG revealed longer duration of delta range slowing due to less hyperemia at the end of plateau waves, resulting in less cerebral blood flow and brain oxygenation.…”

Section: Discussionmentioning

confidence: 99%

“…4 First described in 1960, plateau waves are paroxysmal ICP elevations measuring 25% to 72% above mean ICP with sudden onset and offset. 5,6 Cerebral perfusion pressure (CPP) may decrease when ICP suddenly rises, leading to decreased consciousness, tonic posturing of the arms and legs, neck and back arching, nausea and vomiting, or urinary and fecal incontinence. 7 Attacks may be induced by changes in position, typically last minutes, and resolve between episodes.…”

Section: Introductionmentioning

confidence: 99%

Electrographic Correlates of Plateau Waves in Patients With Leptomeningeal Metastases

Gold

Odom

Srinivasan

et al. 2016

The Neurohospitalist

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We describe video electroencephalography (video-EEG) correlates of transient neurological attacks due to plateau waves-paroxysmal elevations in intracranial pressure-in patients with leptomeningeal metastases. We identified 3 patients with leptomeningeal metastases, intracranial hypertension, and transient neurological attacks captured on video-EEG without evidence of seizures or epileptiform activity. We identified all clinical events on video and reviewed the corresponding EEG data for evidence of abnormalities. All 3 patients had mild to moderate slowing and 2 had frontal intermittent rhythmic delta activity during background EEG recording. There were 33 clinical events recorded and stereotyped for each patient. All 33 events were associated with an increase in delta range slowing of ≥30% compared to the background. This abnormality started ≤2 minutes before the onset of clinical symptoms and persisted for minutes after clinical resolution. This study is the first to carefully describe the electrographic correlates of transient neurological attacks due to plateau waves in patients with leptomeningeal metastasis. Clinical attacks were consistently associated with a possible EEG signature of diffuse delta range slowing. Future studies can validate the sensitivity and specificity of these EEG changes as a prognostic and/or response biomarker in patients with leptomeningeal metastases with or without intracranial hypertension.

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“…These waves begin and end abruptly when ICP rises between 25% and 72% above the mean. 8 The duration of these ICP elevations has been reported between 5 and 20 minutes. 9 The pathophysiology of these transient neurologic events is thought to be a result of reduced cerebral perfusion pressure (CPP).…”

Section: Oy-stersmentioning

confidence: 99%

Pearls & Oy-sters: Transient neurologic events in a patient with leptomeningeal metastases

2017

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Changes in Cerebral Partial Oxygen Pressure and Cerebrovascular Reactivity During Intracranial Pressure Plateau Waves

Cited by 14 publications

References 54 publications

Observations on the Cerebral Effects of Refractory Intracranial Hypertension After Severe Traumatic Brain Injury

Observations on the Cerebral Effects of Refractory Intracranial Hypertension After Severe Traumatic Brain Injury

Electrographic Correlates of Plateau Waves in Patients With Leptomeningeal Metastases

Pearls & Oy-sters: Transient neurologic events in a patient with leptomeningeal metastases

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