What shapes pulse amplitude of intracranial pressure?

Emmanuel Carrera, Dong Joo Kim, Gianluca Castellani, Christian Zweifel, Zofia Czosnyka, Magdalena Kasparowicz, Peter Smielewski, John D. Pickard, Marek Czosnyka

Research output: Contribution to journalArticlepeer-review

77 Citations (Scopus)


The pulsatile component of intracranial pressure (ICP) has been shown to be a predictor of outcome in normal pressure hydrocephalus (NPH) and traumatic brain injury (TBI). Experimental studies have demonstrated that the pulse amplitude of ICP (AMPICP) is dependent on the mean ICP (mICP), and on the pulse amplitude of the cerebral arterial blood volume (AMPCaBV), according to the exponential craniospinal compliance curve. In this study, we compared the influence of mICP and AMPCaBV on AMPICP in patients with NPH (infusion study) and TBI (spontaneous recording). We retrospectively analyzed 25 NPH and 43 TBI patients with continuous monitoring of ICP and cerebral blood flow velocity (CBFV), as assessed with transcranial doppler. AMPCaBV was extracted from the CBFV waveform. The influence of mICP and AMPCaBV on AMPICP were determined using partial coefficients a, b, and c of the multiple regression model: AMP ICP=a * mICP+b * AMPCaBV+c. AMPICP was more dependent on mICP in NPH patients than in TBI patients (partial coefficient a=0.93 versus -0.03; p<0.001). On the contrary, AMPICP was more dependent on AMPCaBV in patients with TBI than in those with NPH (b=0.86 versus 0.10; p<0.001). This study shows that AMP ICP depends mostly on changes in mean ICP during cerebrospinal fluid (CSF) infusion studies in patients with NPH, and on changes in cerebral arterial blood volume (AMPCaBV) in TBI patients. Further clinical studies will reveal whether AMPICP is a better indicator of clinical severity and outcome than mICP in TBI and NPH patients.

Original languageEnglish
Pages (from-to)317-324
Number of pages8
JournalJournal of Neurotrauma
Issue number2
Publication statusPublished - 2010 Feb 1
Externally publishedYes


  • Cerebral blood flow autoregulation
  • Cerebral blood flow velocity
  • Intracranial pressure
  • Neurodegenerative disorders
  • Traumatic brain injury

ASJC Scopus subject areas

  • Clinical Neurology


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