CSF pressure assessed by lumbar puncture agrees with intracranial pressure

Lenfeldt, Niklas; Koskinen, Lars-Owe D.; Bergenheim, A. Tommy; Malm, Jan; Eklund, Anders

doi:10.1212/01.wnl.0000250270.54587.71

Cited by 142 publications

(121 citation statements)

References 11 publications

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“…We measured the lumbar CSF pressure, which was shown to agree with the ICP 22 . Through a hole in the back of the bed a ∅1.2 mm (18G) needle was placed in the spinal canal in contact with the CSF; care was taken to insert the needle with minimal CSF leakage.…”

Section: Investigational Protocolmentioning

confidence: 81%

The pressure difference between eye and brain changes with posture

Eklund

Jóhannesson

Johansson

et al. 2016

Annals of Neurology

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Objective: The discovery of a posture-dependent effect on the difference between intraocular pressure (IOP) and intracranial pressure (ICP) at the level of lamina cribrosa could have important implications for understanding glaucoma and idiopathic intracranial hypertension and could help explain visual impairments in astronauts exposed to microgravity. The aim of this study was to determine the postural influence on the difference between simultaneously measured ICP and IOP.Methods: Eleven healthy adult volunteers (age 46±10 years) were investigated with simultaneous ICP, assessed through lumbar puncture, and IOP measurements when supine, sitting, and in 9° head down tilt (HDT). The trans-lamina cribrosa pressure difference (TLCPD) was calculated as the difference between the IOP and ICP. To estimate the pressures at the lamina cribrosa, geometrical distances were estimated from MRI and were used to adjust for hydrostatic effects. Results:The TLCPD (mm Hg) between IOP and ICP was 12.3±2.2 for supine, 19.8±4.6 for sitting and 6.6±2.5 for HDT. The expected 24-hour average TLCPD on earthassuming 8 h supine and 16 h upright-was estimated to be 17.3 mm Hg. By removing the hydrostatic effects on pressure, a corresponding 24 h-average TLCPD in microgravity environment was simulated to be 6.7 mmHg. Interpretation:We provide a possible physiological explanation for how microgravity can cause symptoms similar to those seen in patients with elevated ICP. The observed posture dependency of TLCPD also implies that assessment of the difference between IOP and ICP in upright may offer new understanding of the pathophysiology of idiopathic intracranial hypertension and glaucoma.

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Section: Investigational Protocolmentioning

confidence: 81%

The pressure difference between eye and brain changes with posture

Eklund

Jóhannesson

Johansson

et al. 2016

Annals of Neurology

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“…Our results are the first based on actual long-term ICP measurements in patients not investigated for, or suspected of, CSF dynamic disturbances, or ICP estimations based on recumbent lumbar CSF pressure measurements in healthy volunteers. 9 Using ventricular ICP measurements, Lundberg 10 estimated a normal supine ICP between 0 and 11 mm Hg based on a single case, which he noted "… can, however, be regarded as probably representative of a normal [ventricular fluid pressure]." This person was a 45-year-old woman with bilateral papilledema of unknown origin, and had complaints of headache and symptoms of "mental insufficiency" for a period of 2 years after acute meningoencephalitis.…”

Section: Discussionmentioning

confidence: 99%

“…10 However, despite widespread use of ICP monitoring, normal ICP has never been thoroughly investigated, and current normal values are extrapolated from lumbar CSF pressure measurements and direct ICP measurements in patients with suspected CSF pressure disorders. Disagreement exists as to whether lumbar pressure measurements can adequately describe qualities of the "true" ICP, 4,9 and certainly in the face of obstructive lesions, the two pressures will differ.…”

Section: ©Aans 2014mentioning

confidence: 99%

Intracranial pressure following complete removal of a small demarcated brain tumor: a model for normal intracranial pressure in humans

Andresen¹,

Juhler²

2014

JNS

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Object. Current published normal values for intracranial pressure (ICP) are extrapolated from lumbar CSF pressure measurements and ICP measurements in patients treated for CSF pressure disorders. There is an emerging agreement that true normal ICP values are needed for diagnostic and therapeutic purposes. This study documents normal ICP in humans.Methods. In this study the authors included adult patients scheduled for complete removal of a solitary, clearly demarcated, small brain tumor. The mean age of these patients was 67 years old (range 58-85 years old). Exclusion criteria were intended to create a study population with as normal brains as possible. A new telemetric ICP monitoring device was implanted at the end of surgery and monitoring was conducted 2 and 4 weeks postoperatively.Results. In the supine position, mean ICP was 0.5 ± 4.0 mm Hg at 4 weeks postoperatively. Postural change to the standing position resulted in a decrease in mean ICP to −3.7 ± 3.8 mm Hg. These results show ICP to be considerably lower than previously estimated.Conclusions. This study provides a preliminary reference range for normal ICP in humans. It is the first study to show that ICP in the healthy human brain decreases to negative values when assuming the upright position. If these results are later confirmed in a larger series, they might provide reference values for diagnosis and treatment in patients with CSF-related disorders. New normal values also have implications for future shunt design and the ICP target range in hydrocephalus treatment.

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“…We measured, however, the difference between the intraocular pressure determined in a sitting position and the CSF pressure measured in the left lateral decubitus position, and called it the "trans-lamina pressure difference". In a recent study on patients with communicating hydrocephalus, Lenfeldt and colleagues demonstrated that lumbar CSF pressure measurements correlated excellently to intracranial CSF pressure measurements in patients with communicating CSF systems, with a regression coefficient of 0.98 [31]. A study by Magnaes and colleagues showed that the CSF pressure at eye level (which is at the same level as the occipital prominence when sitting or standing) was on average between 0 and −10 mmHg [32].…”

Section: Discussionmentioning

confidence: 99%