Circadian Biorhythmicity in Normal Pressure Hydrocephalus - A Case Series Report

Continuous monitoring of intracranial pressure is a well established medical procedure. Still, little is known about long-term behavior of intracranial pressure in normal pressure hydrocephalus. The present study is designed to evaluate periodicity of intracranial pressure over long-time scales using intraventricular pressure monitoring in patients with normal pressure hydrocephalus. In addition, the circadian and diurnal patterns of blood pressure and body temperature in those patients are studied. Four patients, selected with "probable" normal pressure hydrocephalus, were monitored for several dozen hours. Intracranial pressure, blood pressure, and body temperature were recorded hourly. Autocorrelation functions were calculated and cross-correlation analysis were carried out to study all the time-series data. Autocorrelation results show that intracranial pressure, blood pressure, and body temperature values follow bimodal (positive and negative) curves over a day. The cross-correlation functions demonstrate causal relationships between intracranial pressure, blood pressure, and body temperature. The results show that long-term fluctuations in intracranial pressure exhibit cyclical patterns with periods of about 24 hours. Continuous intracranial pressure recording in "probable" normal pressure hydrocephalus patients reveals circadian fluctuations not related to the day and night cycle. These fluctuations are causally related to changes in blood pressure and body temperature. The present study reveals the complete loss of the diurnal blood pressure and body temperature rhythmicities in patients with "probable" normal pressure hydrocephalus.