Effect of postural changes on ICP in healthy and ill subjects

TY - JOUR

T1 - Effect of postural changes on ICP in healthy and ill subjects

AU - Petersen, Lonnie G

AU - Juhler, Marianne

PY - 2014/10/14

Y1 - 2014/10/14

N2 - Background Reference values and physiological measurements of intracranial pressure (ICP) are primarily reported in the supine position, while reports of ICP in the vertical position are surprisingly rare considering that humans maintain the vertical position for the majority of the day. In order to distinguish normal human physiology from disease entities such as idiopathic intracranial hypertension and normal pressure hydrocephalus, we investigated ICP in different body postures in both normal and ill subjects. Methods Thirty-one patients were included: four normal patients following complete removal of a solitary clearly demarcated small brain tumour and fitted with a telemetric ICP monitoring device for long-term ICP monitoring; 27 patients requiring invasive ICP monitoring as a part of their diagnostic work-up or monitoring of shunt treatment effect. ICP was recorded in the following body positions: upright standing, sitting in a chair, supine and right lateral lumbar puncture position. Results Linear regression of median ICP based on patient posture, group, and purpose of monitoring presented a significant model (p<0.001), but could not distinguish between patient groups (p=0.88). Regression of differences in median ICP between body postures and supine ICP as the baseline, presented a highly significant model (p<0.001) and adjusted R2=0.86. Both body posture (p<0.001) and patient group (p<0.001) were highly significant factors. Conclusions Differences in ICP between body postures enabled us to distinguish the normal group from patient groups. Normal patients appear able to more tightly regulate ICP when switching body postures.

AB - Background Reference values and physiological measurements of intracranial pressure (ICP) are primarily reported in the supine position, while reports of ICP in the vertical position are surprisingly rare considering that humans maintain the vertical position for the majority of the day. In order to distinguish normal human physiology from disease entities such as idiopathic intracranial hypertension and normal pressure hydrocephalus, we investigated ICP in different body postures in both normal and ill subjects. Methods Thirty-one patients were included: four normal patients following complete removal of a solitary clearly demarcated small brain tumour and fitted with a telemetric ICP monitoring device for long-term ICP monitoring; 27 patients requiring invasive ICP monitoring as a part of their diagnostic work-up or monitoring of shunt treatment effect. ICP was recorded in the following body positions: upright standing, sitting in a chair, supine and right lateral lumbar puncture position. Results Linear regression of median ICP based on patient posture, group, and purpose of monitoring presented a significant model (p<0.001), but could not distinguish between patient groups (p=0.88). Regression of differences in median ICP between body postures and supine ICP as the baseline, presented a highly significant model (p<0.001) and adjusted R2=0.86. Both body posture (p<0.001) and patient group (p<0.001) were highly significant factors. Conclusions Differences in ICP between body postures enabled us to distinguish the normal group from patient groups. Normal patients appear able to more tightly regulate ICP when switching body postures.

KW - Adolescent

KW - Adult

KW - Aged

KW - Case-Control Studies

KW - Cerebrospinal Fluid Pressure

KW - Child

KW - Female

KW - Humans

KW - Hydrocephalus, Normal Pressure

KW - Intracranial Hypertension

KW - Intracranial Pressure

KW - Male

KW - Middle Aged

KW - Posture

U2 - 10.1007/s00701-014-2250-2

DO - 10.1007/s00701-014-2250-2

M3 - Journal article

C2 - 25307778

SN - 0001-6268

VL - 157

SP - 109

EP - 113

JO - Acta Neurochirurgica

JF - Acta Neurochirurgica

IS - 1

ER -