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Cerebrovascular pressure-reactivity in normal pressure hydrocephalus

Clinical background

We investigated the possible relationship between vascular reactivity and the resistance to CSF outflow in a group of shunted and non-shunted NPH patients.

Materials and Methods

Sixty eight patients (47 non-shunted and 21 shunted) with NPH have been examined. During the examination ICP was measured in the ventricles (using a needle inserted into a pre-implanted Ommaya reservoir) at baseline and in response to a constant rate infusion (1.5 ml/min) of normal saline. Resistance to CSF outflow (Rcsf) was measured as an increase of ICP divided by the infusion rate. During the test, arterial pressure was monitored continuously using a Finapress finger cuff. Cerebrovascular pressure-reactivity was assessed as a moving correlation coefficient between coherent 'slow waves' of ICP and spontaneous fluctuations of arterial blood pressure (PRx index). This variable has been demonstrated previously to correlate with autoregulation of CBF [1]. Positive value of PRx reveals impaired cerebrovascular pressure-reactivity, whereas negative values indicate normal reactivity.


In non-shunted patients impaired pressure reactivity was associated with lower resistance to CSF outflow: (PRx versus Rcsf: R = -0.5; P < 0.0005). This relationship was inverted in shunted patients: PRx was positively correlated with Rcsf (R = 0.51; P < 0.03).


Cerebrovascular pressure-reactivity is disturbed in patients with normal resistance to CSF outflow, suggesting underlying cerebrovascular disease. After shunting the pressure-reactivity strongly depends on shunt function and may deteriorate when the shunt malfunctions.


  1. Czosnyka M, et al: Neurosurgery. 1997, 41: 11-19. 10.1097/00006123-199707000-00005.

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Correspondence to ZH Czosnyka.

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Czosnyka, Z., Van Den Boogaard, F., Czosnyka, M. et al. Cerebrovascular pressure-reactivity in normal pressure hydrocephalus. Fluids Barriers CNS 1 (Suppl 1), S20 (2004).

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