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Cerebral blood-flow velocity and intermittent intracranial pressure elevation during sleep in hydrocephalic children

D Goh1, R A Minns, S D Pye

  • 1Department of Paediatric Neurology, Royal Hospital for Sick Children, Edinburgh.

Developmental Medicine and Child Neurology
|August 1, 1992
PubMed

Insights

Intermittent intracranial pressure (ICP) elevations in children with hydrocephalus can be assessed using cerebral blood flow velocity (CBFV). Monitoring ICP and CBFV during sleep helps identify children at risk of ischemic insult.

Area of Science:

  • Pediatric Neurology
  • Neurosurgery
  • Cerebrovascular Physiology

Background:

  • The clinical significance of intermittent intracranial pressure (ICP) elevations during sleep in pediatric hydrocephalus remains poorly understood.
  • Continuous ICP monitoring with simultaneous cerebral blood flow velocity (CBFV) measurements offers a potential method to investigate this phenomenon.

Purpose of the Study:

  • To evaluate the relationship between ICP fluctuations and CBFV during sleep in children with hydrocephalus.
  • To determine if CBFV patterns can indicate impaired hemodynamic compensation and reduced circulatory reserve.

Main Methods:

  • Analysis of eight studies involving continuous ICP monitoring and simultaneous CBFV measurements during sleep.
  • Data collected from seven hydrocephalic children aged 1-10 years, with ICP measured via a frontal reservoir.

Main Results:

  • Two distinct CBFV patterns emerged in response to elevated ICP: a progressive decrease in mean flow velocity and increased resistance index, suggesting impaired hemodynamic compensation.
  • Alternatively, an increase in mean flow velocity with elevated ICP indicated appropriate hemodynamic compensation and maintained cerebral perfusion.

Conclusions:

  • Simultaneous CBFV and ICP monitoring during sleep can differentiate between hydrocephalic children with sufficient and insufficient circulatory reserve.
  • This monitoring may aid in identifying children at higher risk of ischemic insult due to episodic ICP increases.

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