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Irregular Fluctuation of Elevated Cerebrospinal Fluid Pressure: Such Fluctuations as a Measure of Dysfunction of Cerebrovascular Episodes, Pseudotumor Cerebri, and Head Injury

Irregular Fluctuation of Elevated Cerebrospinal Fluid Pressure: Such Fluctuations as a Measure of... Abstract In some patients with increased intracranial pressure there are irregular rapid fluctuations of the pressure. They can be found in the course of routine lumbar puncture in quiet (or sedated) patients by observing the pressure for a few minutes. These pressure changes have been mentioned, briefly and without explanation, in reports of cases of severe head injury,* brain tumor,† cerebral pseudotumor,‡ and acute cerebral vascular disease.6 The purpose of the present study is to seek the origin and significance of these fluctuations. THE CEREBROSPINAL DURA AS AN ONCOMETER Under pressures compatible with life, the cerebrospinal dura is essentially not distensible.7 It contains the central nervous system, cerebrospinal fluid (CSF), and blood, all of which are practically incompressible. The CSF pressure is the sum of the partial tensions exerted by neural tissue, CSF, and intradural blood. The sudden rises and falls in pressure which are the subject of this References 1. References 1 and 2. 2. Grant, F. C., in discussion on Bragdon,2 p. 559. 3. References 1, 2, and 3. 4. References 4 and 5. 5. Falkenheim and Naunyn,9 6. Hill, L.: The Physiology and Pathology of the Cerebral Circulation: An Experimental Research , London, J. & A. Churchill, Ltd., 1896. 7. References 10 and 11. 8. Reference 1. 9. Grant, F. C., in discussion on Bragdon.2 10. References 18 and 19. 11. References 19 and 20. 12. References 17 and 21. 13. References 4 and 5. 14. References 6, 17, and 23. 15. References 25 to 27. 16. References 28 and 29. 17. References 30 to 32. 18. Grant, F. C.: The Value of Hypertonic Solutions by Mouth, by Rectum or by Intravenous Injection for the Reduction of Increased Intracranial Pressure, in The Intracranial Pressure in Health and Disease , A. Res. Nerv. & Ment. Dis., Proc. (1927) 8:437, 1929; Figs. 168-169, p. 443. 19. Bragdon, F. H.: Alterations Observed in Craniocerebral Injuries Following the Use of Dehydrating Agents, in Trauma of the Central Nervous System , A. Res. Nerv. & Ment. Dis., Proc. (1943) 24:545, 1945; Fig. 220, p. 551, and Fig. 228, p. 557. 20. Gardner, W. J.; Spitler, D. K., and Whitten, C.: Increased Intracranial Pressure Caused by Increased Protein Content in the Cerebrospinal Fluid , New England J. M. 250:932 ( (June 3) ) 1954, Case 2. 21. Gardner, W. J.: Active External Hydrocephalus: A Report of 3 Cases , J. Nerv. & Ment. Dis. 75:601 ( (June) ) 1932, Case 1. 22. Gardner, W. J.: Otitic Sinus Thrombosis Causing Intracranial Hypertension , Arch. Otolaryng. 30:253 ( (Aug.) ) 1939, p. 258. 23. Seidenberg, R., and Ecker, A.: Psychodynamic and Arteriographic Studies of Acute Cerebral Vascular Disorders: Report of 6 Patients Under the Age of 50 Without Gross Pathogenic Lesions , Psychosom. Med. 16:374 ( (Sept.-Oct.) ) 1954; Case 2. 24. Weed, L. H.: Experimental Studies of Intracranial Pressure, in The Intracranial Pressure in Health and Disease , A. Res. Nerv. & Ment. Dis. Proc. (1927) 8:25, 1929, p. 30. 25. Dandy, W. E.: Intracranial Pressure Without Brain Tumor: Diagnosis and Treatment , Ann. Surg. 106:492 ( (Oct.) ) 1937, p. 513. 26. Falkenheim and Naunyn: Arch. exper. path. u. Pharmakol. 22:261, 1887. 27. Roseman, E.; Rosenbaum, M.; Aring, C. D., and Ferris, E. B.: Cerebrospinal Fluid Dynamics in Man , Arch. Neurol. & Psychiat. 46:72 ( (July) ) 1941. 28. Bowsher, D.: The Cerebrospinal Fluid Pressure , Brit. M. J. 1:863 ( (April 18) ) 1953. 29. Ferris, E. B.: Objective Measurement of Relative Intracranial Blood Flow in Man, with Observations Concerning the Hydrodynamics of the Craniovertebral System , Arch. Neurol. & Psychiat. 46:377 ( (Sept.) ) 1941. 30. O'Connell, J. E. A.: The Vascular Factor in Intracranial Pressure and the Maintenance of the Cerebrospinal Fluid Circulation , Brain 66:204 ( (Sept.) ) 1943. 31. Ecker, A.: Spasm of the Internal Carotid Artery , J. Neurosurg. 2:479 ( (Nov.) ) 1945. 32. Löhr, W.: Arteriographic Demonstration of Cerebral Vascular Trauma: Vascular Changes in Cerebral Concussion and Contusion , Zentralbl. Chir. 63:2642 ( (Nov. 7) ) 1936. 33. Egas Moniz: Diagnosis of Cerebral Tumors and Proof of Arterial Encephalography , Paris, Masson & Cie, 1931, Chap. 8, p. 173-195. 34. Ecker, A., and Riemenschneider, P. A.: Arteriographic Evidence of Spasm in Cerebral Vascular Disorders , Neurology 3:495 ( (July) ) 1953. 35. Ray, B. S.; Dunbar, H. S., and Dotter, C. T.: Dural Sinus Venography as an Aid to Diagnosis in Intracranial Disease , J. Neurosurg. 8:23 ( (Jan.) ) 1951. 36. Ray, B. S., and Dunbar, H. S.: Thrombosis of the Dural Venous Sinuses as a Cause of "Pseudotumor Cerebri," Ann. Surg. 134:376 ( (Sept.) ) 1951; Case 1. 37. Barnett, H. J. M., and Hyland, H. H.: Non-Infective Intracranial Venous Thrombosis , Brain 76:36 ( (March) ) 1953; p. 43. 38. Ecker, A.: The Normal Cerebral Angiogram , Springfield, Ill., Charles C Thomas, Publisher, 1951, p. 154. 39. Aring, C. D.: Vascular Diseases of the Nervous System , Brain 68:28 ( (March) ) 1945. 40. Ecker, A.: Emotional Stress Before Strokes: A Preliminary Report of 20 Cases , Ann. Int. Med. 40:49 ( (Jan.) ) 1954.Crossref 41. Engel, G. L.; Hamburger, W. W.; Reiser, M., and Plunkett, J.: Electroencephalographic and Psychologic Studies of a Case of Migraine with Severe Pre-Headache Phenomena, with Comments on Cerebral Vasospasm and Focal Hypertensive Encephalopathy , Psychosom. Med. 15:337 ( (July-Aug.) ) 1953.Crossref 42. Westphal, K., and Bär, R.: Concerning the Origin of Strokes: 1. Pathologic-Anatomic Investigations; 2. Clinical Investigations; 3. Experimental Investigations , Deutsches Arch. klin. Med. 151:1 ( (April) ) 1926. 43. Scholz, W.: Histological Investigations Concerning Form, Dynamics, and Pathologic-Anatomic Effects of Functional Disturbances of Cerebral Blood Flow , Ztschr. ges. Neurol. u. Psychiat. 167: 424, 1939.Crossref 44. Hicks, S. P., and Warren, S.: Infarction of the Brain Without Thrombosis , A. M. A. Arch. Path. 52:403 ( (Nov.) ) 1951. 45. Villaret, M., and Cachera, R.: Cerebral Embolism: Experimental Pathological Studies of Solid and Gaseous Emboli of the Brain , Paris, Masson & Cie, 1939. 46. Byrom, F. B.: The Pathogenesis of Hypertensive Encephalopathy and Its Relation to the Malignant Phase of Hypertension: Experimental Evidence from the Hypertensive Rat , Lancet 2:201 ( (July 31) ) 1954.Crossref 47. Wolff, H. G.: Headache and Other Head Pain , New York, Oxford University Press, 1948; Fig. 69, p. 171; Fig. 93, p. 270. 48. Pickering, G. W.: Observations on the Mechanism of Headache Produced by Histamine , Clin. Sc. 1:77 ( (July) ) 1933. 49. Ryder, H. W.; Espey, F. F.; Kristoff, F. V., and Evans, J. P.: Observations on the Interrelationships of Intracranial Pressure and Cerebral Blood Flow , J. Neurosurg. 8:46 ( (Jan.) ) 1951; Fig. 15, p. 55.Crossref 50. Guillaume, J., and Janny, P.: Continuous Intracranial Manometry: Physiopathologic Interest and Clinical Method , Presse méd. 59:953 ( (July 4) ) 1951, Fig. 7. 51. Penfield, W., and Jasper, H.: Epilepsy and the Functional Anatomy of the Human Brain , Boston, Little, Brown & Company, 1954, pp. 256-264. 52. Vujić, W.: Sleep and Pressure of Cerebrospinal Fluid: Contribution to the Physiology and Pathology of Sleep , Jahrb. Psychol. 49:113, 1933. 53. Stevenson, L.; Bryant, C., and Wortis, S. B.: Some Experiments on Intracranial Pressure in Man During Sleep and Under Certain Other Conditions, in the Intracranial Pressure in Health and Disease , A. Res. Nerv. & Ment. Dis., Proc. (1927) 8:130-160, 1929. 54. Folkow, B.: A Study of the Factors Influencing the Tone of Denervated Blood Vessels Perfused at Various Pressures , Acta physiol. scandinav. 27:99, 1952. 55. Ryder, H. W.; Espey, F. F.; Kimbell, F. D.; Penka, E. J.; Rosenauer, A.; Podolsky, B., and Evans, J. P.: Influence of Changes in Cerebral Blood Flow on the Cerebrospinal Fluid Pressure , A. M. A. Arch. Neurol. &. Psychiat. 68:165 ( (Aug.) ) 1952. 56. Ryder, H. W.; Espey, F. F.; Kimbell, F. D.; Penka, E. J.; Rosenauer, A.; Podolsky, B., and Evans, J. P.: Modification of Effect of Cerebral Blood Flow on Cerebrospinal Fluid Pressure by Variation in Craniospinal Blood Volume , A. M. A Arch. Neurol. & Psychiat. 68:170 ( (Aug.) ) 1952. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives of Neurology & Psychiatry American Medical Association

Irregular Fluctuation of Elevated Cerebrospinal Fluid Pressure: Such Fluctuations as a Measure of Dysfunction of Cerebrovascular Episodes, Pseudotumor Cerebri, and Head Injury

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Publisher
American Medical Association
Copyright
Copyright © 1955 American Medical Association. All Rights Reserved.
ISSN
0096-6886
DOI
10.1001/archneurpsyc.1955.02330180059006
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Abstract

Abstract In some patients with increased intracranial pressure there are irregular rapid fluctuations of the pressure. They can be found in the course of routine lumbar puncture in quiet (or sedated) patients by observing the pressure for a few minutes. These pressure changes have been mentioned, briefly and without explanation, in reports of cases of severe head injury,* brain tumor,† cerebral pseudotumor,‡ and acute cerebral vascular disease.6 The purpose of the present study is to seek the origin and significance of these fluctuations. THE CEREBROSPINAL DURA AS AN ONCOMETER Under pressures compatible with life, the cerebrospinal dura is essentially not distensible.7 It contains the central nervous system, cerebrospinal fluid (CSF), and blood, all of which are practically incompressible. The CSF pressure is the sum of the partial tensions exerted by neural tissue, CSF, and intradural blood. The sudden rises and falls in pressure which are the subject of this References 1. References 1 and 2. 2. Grant, F. C., in discussion on Bragdon,2 p. 559. 3. References 1, 2, and 3. 4. References 4 and 5. 5. Falkenheim and Naunyn,9 6. Hill, L.: The Physiology and Pathology of the Cerebral Circulation: An Experimental Research , London, J. & A. Churchill, Ltd., 1896. 7. References 10 and 11. 8. Reference 1. 9. Grant, F. C., in discussion on Bragdon.2 10. References 18 and 19. 11. References 19 and 20. 12. References 17 and 21. 13. References 4 and 5. 14. References 6, 17, and 23. 15. References 25 to 27. 16. References 28 and 29. 17. References 30 to 32. 18. Grant, F. C.: The Value of Hypertonic Solutions by Mouth, by Rectum or by Intravenous Injection for the Reduction of Increased Intracranial Pressure, in The Intracranial Pressure in Health and Disease , A. Res. Nerv. & Ment. Dis., Proc. (1927) 8:437, 1929; Figs. 168-169, p. 443. 19. Bragdon, F. H.: Alterations Observed in Craniocerebral Injuries Following the Use of Dehydrating Agents, in Trauma of the Central Nervous System , A. Res. Nerv. & Ment. Dis., Proc. (1943) 24:545, 1945; Fig. 220, p. 551, and Fig. 228, p. 557. 20. Gardner, W. J.; Spitler, D. K., and Whitten, C.: Increased Intracranial Pressure Caused by Increased Protein Content in the Cerebrospinal Fluid , New England J. M. 250:932 ( (June 3) ) 1954, Case 2. 21. Gardner, W. J.: Active External Hydrocephalus: A Report of 3 Cases , J. Nerv. & Ment. Dis. 75:601 ( (June) ) 1932, Case 1. 22. Gardner, W. J.: Otitic Sinus Thrombosis Causing Intracranial Hypertension , Arch. Otolaryng. 30:253 ( (Aug.) ) 1939, p. 258. 23. Seidenberg, R., and Ecker, A.: Psychodynamic and Arteriographic Studies of Acute Cerebral Vascular Disorders: Report of 6 Patients Under the Age of 50 Without Gross Pathogenic Lesions , Psychosom. Med. 16:374 ( (Sept.-Oct.) ) 1954; Case 2. 24. Weed, L. H.: Experimental Studies of Intracranial Pressure, in The Intracranial Pressure in Health and Disease , A. Res. Nerv. & Ment. Dis. Proc. (1927) 8:25, 1929, p. 30. 25. Dandy, W. E.: Intracranial Pressure Without Brain Tumor: Diagnosis and Treatment , Ann. Surg. 106:492 ( (Oct.) ) 1937, p. 513. 26. Falkenheim and Naunyn: Arch. exper. path. u. Pharmakol. 22:261, 1887. 27. Roseman, E.; Rosenbaum, M.; Aring, C. D., and Ferris, E. B.: Cerebrospinal Fluid Dynamics in Man , Arch. Neurol. & Psychiat. 46:72 ( (July) ) 1941. 28. Bowsher, D.: The Cerebrospinal Fluid Pressure , Brit. M. J. 1:863 ( (April 18) ) 1953. 29. Ferris, E. B.: Objective Measurement of Relative Intracranial Blood Flow in Man, with Observations Concerning the Hydrodynamics of the Craniovertebral System , Arch. Neurol. & Psychiat. 46:377 ( (Sept.) ) 1941. 30. O'Connell, J. E. A.: The Vascular Factor in Intracranial Pressure and the Maintenance of the Cerebrospinal Fluid Circulation , Brain 66:204 ( (Sept.) ) 1943. 31. Ecker, A.: Spasm of the Internal Carotid Artery , J. Neurosurg. 2:479 ( (Nov.) ) 1945. 32. Löhr, W.: Arteriographic Demonstration of Cerebral Vascular Trauma: Vascular Changes in Cerebral Concussion and Contusion , Zentralbl. Chir. 63:2642 ( (Nov. 7) ) 1936. 33. Egas Moniz: Diagnosis of Cerebral Tumors and Proof of Arterial Encephalography , Paris, Masson & Cie, 1931, Chap. 8, p. 173-195. 34. Ecker, A., and Riemenschneider, P. A.: Arteriographic Evidence of Spasm in Cerebral Vascular Disorders , Neurology 3:495 ( (July) ) 1953. 35. Ray, B. S.; Dunbar, H. S., and Dotter, C. T.: Dural Sinus Venography as an Aid to Diagnosis in Intracranial Disease , J. Neurosurg. 8:23 ( (Jan.) ) 1951. 36. Ray, B. S., and Dunbar, H. S.: Thrombosis of the Dural Venous Sinuses as a Cause of "Pseudotumor Cerebri," Ann. Surg. 134:376 ( (Sept.) ) 1951; Case 1. 37. Barnett, H. J. M., and Hyland, H. H.: Non-Infective Intracranial Venous Thrombosis , Brain 76:36 ( (March) ) 1953; p. 43. 38. Ecker, A.: The Normal Cerebral Angiogram , Springfield, Ill., Charles C Thomas, Publisher, 1951, p. 154. 39. Aring, C. D.: Vascular Diseases of the Nervous System , Brain 68:28 ( (March) ) 1945. 40. Ecker, A.: Emotional Stress Before Strokes: A Preliminary Report of 20 Cases , Ann. Int. Med. 40:49 ( (Jan.) ) 1954.Crossref 41. Engel, G. L.; Hamburger, W. W.; Reiser, M., and Plunkett, J.: Electroencephalographic and Psychologic Studies of a Case of Migraine with Severe Pre-Headache Phenomena, with Comments on Cerebral Vasospasm and Focal Hypertensive Encephalopathy , Psychosom. Med. 15:337 ( (July-Aug.) ) 1953.Crossref 42. Westphal, K., and Bär, R.: Concerning the Origin of Strokes: 1. Pathologic-Anatomic Investigations; 2. Clinical Investigations; 3. Experimental Investigations , Deutsches Arch. klin. Med. 151:1 ( (April) ) 1926. 43. Scholz, W.: Histological Investigations Concerning Form, Dynamics, and Pathologic-Anatomic Effects of Functional Disturbances of Cerebral Blood Flow , Ztschr. ges. Neurol. u. Psychiat. 167: 424, 1939.Crossref 44. Hicks, S. P., and Warren, S.: Infarction of the Brain Without Thrombosis , A. M. A. Arch. Path. 52:403 ( (Nov.) ) 1951. 45. Villaret, M., and Cachera, R.: Cerebral Embolism: Experimental Pathological Studies of Solid and Gaseous Emboli of the Brain , Paris, Masson & Cie, 1939. 46. Byrom, F. B.: The Pathogenesis of Hypertensive Encephalopathy and Its Relation to the Malignant Phase of Hypertension: Experimental Evidence from the Hypertensive Rat , Lancet 2:201 ( (July 31) ) 1954.Crossref 47. Wolff, H. G.: Headache and Other Head Pain , New York, Oxford University Press, 1948; Fig. 69, p. 171; Fig. 93, p. 270. 48. Pickering, G. W.: Observations on the Mechanism of Headache Produced by Histamine , Clin. Sc. 1:77 ( (July) ) 1933. 49. Ryder, H. W.; Espey, F. F.; Kristoff, F. V., and Evans, J. P.: Observations on the Interrelationships of Intracranial Pressure and Cerebral Blood Flow , J. Neurosurg. 8:46 ( (Jan.) ) 1951; Fig. 15, p. 55.Crossref 50. Guillaume, J., and Janny, P.: Continuous Intracranial Manometry: Physiopathologic Interest and Clinical Method , Presse méd. 59:953 ( (July 4) ) 1951, Fig. 7. 51. Penfield, W., and Jasper, H.: Epilepsy and the Functional Anatomy of the Human Brain , Boston, Little, Brown & Company, 1954, pp. 256-264. 52. Vujić, W.: Sleep and Pressure of Cerebrospinal Fluid: Contribution to the Physiology and Pathology of Sleep , Jahrb. Psychol. 49:113, 1933. 53. Stevenson, L.; Bryant, C., and Wortis, S. B.: Some Experiments on Intracranial Pressure in Man During Sleep and Under Certain Other Conditions, in the Intracranial Pressure in Health and Disease , A. Res. Nerv. & Ment. Dis., Proc. (1927) 8:130-160, 1929. 54. Folkow, B.: A Study of the Factors Influencing the Tone of Denervated Blood Vessels Perfused at Various Pressures , Acta physiol. scandinav. 27:99, 1952. 55. Ryder, H. W.; Espey, F. F.; Kimbell, F. D.; Penka, E. J.; Rosenauer, A.; Podolsky, B., and Evans, J. P.: Influence of Changes in Cerebral Blood Flow on the Cerebrospinal Fluid Pressure , A. M. A. Arch. Neurol. &. Psychiat. 68:165 ( (Aug.) ) 1952. 56. Ryder, H. W.; Espey, F. F.; Kimbell, F. D.; Penka, E. J.; Rosenauer, A.; Podolsky, B., and Evans, J. P.: Modification of Effect of Cerebral Blood Flow on Cerebrospinal Fluid Pressure by Variation in Craniospinal Blood Volume , A. M. A Arch. Neurol. & Psychiat. 68:170 ( (Aug.) ) 1952.

Journal

A.M.A. Archives of Neurology & PsychiatryAmerican Medical Association

Published: Dec 1, 1955

References

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