Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, B15 2TT, Birmingham, UK.
Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, B15 2TH, Birmingham, UK.
Fluids Barriers CNS. 2022 Nov 1;19(1):85. doi: 10.1186/s12987-022-00384-2.
Intracranial pressure (ICP) has been thought to vary diurnally. This study evaluates diurnal ICP measurements and quantifies changes in ICP occurring with changes in body posture in active idiopathic intracranial hypertension (IIH).
This prospective observational study utilized telemetric ICP monitoring in people with active IIH. Participants had the Raumedic p-Tel ICP intraparenchymal device (Raumedic, Hembrechts, Germany) surgically inserted. Changes in ICP in the supine position were evaluated. Then, the ICP was measured in the standing, sitting, supine, left lateral decubitus positions and with coughing and bending. Ultimately, changes in ICP over the course of 24 h were recorded. ISRCTN registration number 12678718.
15 women were included, mean (standard deviation) age 29.5 (9.5) years, body mass index 38.1 (6.2) kg/m, and baseline mean ICP of 21.2 (4.8) mmHg (equivalent to 28.8 (6.5) cmCSF). Mean ICP rose with the duration in the supine position 1.2 (3.3) mmHg over 5-minutes (p = 0.175), 3.5 (2.8) mmHg over 30-minutes (p = 0.0002) and by a further 2.1 (2.2) mmHg over 3 h (p = 0.042). Mean ICP decreased by 51% when moving from the supine position to standing (21.2 (4.8) mmHg to 10.3 (3.7) mmHg respectively, p = 0.0001). Mean ICP increased by 13% moving from supine to the left lateral decubitus position (21.2 (4.8) mmHg to 24.0 (3.8) mmHg, p = 0.028). There was no significant difference in ICP measurements at any point during the daytime, or between 5-minute standing or supine recordings and prolonged ambulatory daytime and end of night supine recordings respectively. ICP, following an initial drop, increased progressively in conjunction with lying supine position from 23:00 h to 07:00 h by 34% (5.2 (1.9) mmHg, p = 0.026).
This analysis demonstrated that ICP does not appear to have a diurnal variation in IIH, but varies by position and duration in the supine position. ICP rose at night whilst the patient was continuously supine. Furthermore, brief standing and supine ICP measures in the day predicted daytime prolonged ambulatory measures and end of night peak ICP respectively. This knowledge gives reassurance that ICP can be accurately measured and compared at any time of day in an ambulant IIH patient. These are useful findings to inform clinical measurements and in the interpretation of ICP analyses in IIH.
ISTCRN (12678718).
颅内压（ICP）被认为存在昼夜变化。本研究评估了活跃性特发性颅内高压（IIH）患者的日间 ICP 测量值，并量化了体位变化时 ICP 的变化。
本前瞻性观察性研究利用遥测 ICP 监测仪对活跃性 IIH 患者进行监测。参与者接受了 Raumedic p-Tel ICP 脑室内装置（Raumedic，Hembrechts，德国）的手术植入。评估了仰卧位时 ICP 的变化。然后，测量了直立位、坐位、仰卧位、左侧卧位以及咳嗽和弯曲时的 ICP。最终，记录了 24 小时内 ICP 的变化。ISRCTN 注册号为 12678718。
共纳入 15 名女性，平均（标准差）年龄为 29.5（9.5）岁，体重指数为 38.1（6.2）kg/m²，基线平均 ICP 为 21.2（4.8）mmHg（相当于 28.8（6.5）cmCSF）。仰卧位持续时间与 ICP 升高相关，5 分钟时升高 1.2（3.3）mmHg（p=0.175），30 分钟时升高 3.5（2.8）mmHg（p=0.0002），3 小时时升高 2.1（2.2）mmHg（p=0.042）。从仰卧位转为直立位时，ICP 降低 51%（分别为 21.2（4.8）mmHg 和 10.3（3.7）mmHg，p=0.0001）。从仰卧位转为左侧卧位时，ICP 升高 13%（分别为 21.2（4.8）mmHg 和 24.0（3.8）mmHg，p=0.028）。日间任意时间点、5 分钟站立或仰卧位记录与日间持续站立和夜间末仰卧位记录之间，ICP 测量值均无显著差异。从 23:00 到 07:00，ICP 初始下降后逐渐升高，与持续仰卧位有关，升高 34%（5.2（1.9）mmHg，p=0.026）。
本分析表明，IIH 患者的 ICP 似乎没有昼夜变化，但会随体位和仰卧位持续时间而变化。夜间患者持续仰卧时，ICP 升高。此外，日间短暂的站立和仰卧位 ICP 测量值分别预测了日间持续活动时的测量值和夜间末的峰值 ICP。这一发现让我们对在 IIH 患者任何时间点都能准确测量和比较 ICP 有了信心。这些发现对于指导临床测量和解释 IIH 中的 ICP 分析非常有用。
ISTCRN（12678718）。
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