Continuous monitoring of the Monro-Kellie doctrine: Is it possible?

Dong Ju Kim, Zofia Czosnyka, Magdalena Kasprowicz, Piotr Smieleweski, Oliver Baledent, Anne Marie Guerguerian, John D. Pickard, Marek Czosnyka

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

The Monro-Kellie doctrine describes the principle of homeostatic intracerebral volume regulation, which stipulates that the total volume of the parenchyma, cerebrospinal fluid, and blood remains constant. Hypothetically, a slow shift (e.g., brain edema development) in the irregular vasomotion-driven exchanges of these compartmental volumes may lead to increased intracranial hypertension. To evaluate this paradigm in a clinical setting and measure the processes involved in the regulation of systemic intracranial volume, we quantified cerebral blood flow velocity (CBFv) in the middle cerebral artery, arterial blood pressure (ABP), and intracranial pressure (ICP), in 238 brain-injured subjects. Relative changes in compartmental compliances C a (arterial) and Ci (combined venous and CSF compartments) were mathematically estimated using these raw signals through time series analysis; Ca and Ci were used to compute an index of cerebral compliance (ICC) as a moving correlation coefficient between C a and Ci. Conceptually, a negative ICC would represent a functional Monro-Kellie doctrine by illustrating volumetric compensations between Ca and Ci. Clinical observations show that Lundberg A-waves and arterial hypertension were associated with negative ICC, whereas in refractory intracranial hypertension, a positive ICC was observed. In subjects who died, ICC was significantly greater than in survivors (0.46±0.027 versus 0.22±0.017; p<0.01) over the first 5 days of intensive care. The mortality rate is 5% when ICC is less than 0, and 43% when above 0.7. ICC above 0.7 was associated with terminally elevated ICP (chi-square p=0.026). We propose that the Monro-Kellie doctrine can be monitored in real time to illustrate the state of intracranial volume regulation.

Original languageEnglish
Pages (from-to)1354-1363
Number of pages10
JournalJournal of Neurotrauma
Volume29
Issue number7
DOIs
Publication statusPublished - 2012 May 1

Fingerprint

Compliance
Intracranial Hypertension
Cerebrovascular Circulation
Process Assessment (Health Care)
Blood Flow Velocity
Brain Edema
Middle Cerebral Artery
Intracranial Pressure
Critical Care
Survivors
Cerebrospinal Fluid
Arterial Pressure
Hypertension
Mortality
Brain

Keywords

  • cerebral blood volume
  • cerebral compliance
  • compensatory mechanism
  • CSF compartment
  • traumatic brain injury
  • vascular compartment

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Kim, D. J., Czosnyka, Z., Kasprowicz, M., Smieleweski, P., Baledent, O., Guerguerian, A. M., ... Czosnyka, M. (2012). Continuous monitoring of the Monro-Kellie doctrine: Is it possible? Journal of Neurotrauma, 29(7), 1354-1363. https://doi.org/10.1089/neu.2011.2018

Continuous monitoring of the Monro-Kellie doctrine : Is it possible? / Kim, Dong Ju; Czosnyka, Zofia; Kasprowicz, Magdalena; Smieleweski, Piotr; Baledent, Oliver; Guerguerian, Anne Marie; Pickard, John D.; Czosnyka, Marek.

In: Journal of Neurotrauma, Vol. 29, No. 7, 01.05.2012, p. 1354-1363.

Research output: Contribution to journalArticle

Kim, DJ, Czosnyka, Z, Kasprowicz, M, Smieleweski, P, Baledent, O, Guerguerian, AM, Pickard, JD & Czosnyka, M 2012, 'Continuous monitoring of the Monro-Kellie doctrine: Is it possible?', Journal of Neurotrauma, vol. 29, no. 7, pp. 1354-1363. https://doi.org/10.1089/neu.2011.2018
Kim DJ, Czosnyka Z, Kasprowicz M, Smieleweski P, Baledent O, Guerguerian AM et al. Continuous monitoring of the Monro-Kellie doctrine: Is it possible? Journal of Neurotrauma. 2012 May 1;29(7):1354-1363. https://doi.org/10.1089/neu.2011.2018
Kim, Dong Ju ; Czosnyka, Zofia ; Kasprowicz, Magdalena ; Smieleweski, Piotr ; Baledent, Oliver ; Guerguerian, Anne Marie ; Pickard, John D. ; Czosnyka, Marek. / Continuous monitoring of the Monro-Kellie doctrine : Is it possible?. In: Journal of Neurotrauma. 2012 ; Vol. 29, No. 7. pp. 1354-1363.
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