A proposed mechanism to explain increases in intracranial pressure: The concept of cerebral artery wedge pressure
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Abstract
We hypothesize that, with elevated cerebral spinal fluid (CSF) pressure, cerebral micro-vascular obstruction and congestion may occur despite (subdural) large-vein pressures being normal. Smaller veins emptying into these larger, dura-enveloped veins are not immune to the compressive effects of elevated CSF pressure and a “Starling Resistor” mechanism might explain why elevated CSF pressures collapse these smaller veins. This small cerebral venous starling resistor compression mechanism may be the final common pathway for many patients suffering from increased CSF pressures and might also be an important contributor to impaired focal venous drainage presenting as a headache with normal venous sinus pressures.
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Friedman DI. Cerebral venous pressure, intra-abdominal pressure, and dural venous sinus stenting in idiopathic intracranial hypertension. J Neuroophthalmol. 2006; 26: 61-64. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16518170 DOI: https://doi.org/10.1097/01.wno.0000204663.33559.1e
Albuquerque FC, Dashti SR, Hu YC, Newman CB, Teleb M, et al. Intracranial venous sinus stenting for benign intracranial hypertension: clinical indications, technique, and preliminary results. World neurosurg. 2011; 75: 648-652. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21704931 DOI: https://doi.org/10.1016/j.wneu.2010.11.012
Johnston I, Paterson A. Benign intracranial hypertension. II. CSF pressure and circulation. Brain. 1974; 97: 301-12. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/4434179 DOI: https://doi.org/10.1093/brain/97.1.301
King JO, Mitchell PJ, Thomson KR, Tress BM. Cerebral venography and manometry in idiopathic intracranial hypertension. Neurology. 1995; 45: 2224-2228. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8848197 DOI: https://doi.org/10.1212/WNL.45.12.2224
Magder S. Starling resistor versus compliance. Which explains the zero-flow pressure of a dynamic arterial pressure-flow relation? Circulation res. 1990; 67: 209-220. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/2364491 DOI: https://doi.org/10.1161/01.RES.67.1.209
Swan HJ, Ganz W, Forrester J, Marcus H, Diamond G, et al. Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N Engl J Med. 1970; 283: 447-451. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/5434111 DOI: https://doi.org/10.1056/NEJM197008272830902
Kubiak GM, Ciarka A, Biniecka M, Ceranowicz P. Right Heart Catheterization-Background, Physiological Basics, and Clinical Implications. J Clin Med. 2019; 8. E1331. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31466390 DOI: https://doi.org/10.3390/jcm8091331
Daniel PMD, JD, Prichard MM. Studies of the Carotid Rete and Its Associated Arteries. Phil Trans Roy Soc London. 1953; 237: 173-208. PubMed: DOI: https://doi.org/10.1098/rstb.1953.0003
Wang H, Kim M, Normoyle KP, Llano D. Thermal Regulation of the Brain-An Anatomical and Physiological Review for Clinical Neuroscientists. Front Neurosci. 2015; 9: 528. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26834552 DOI: https://doi.org/10.3389/fnins.2015.00528