Phase-shift between arterial flow and ICP pulse during infusion test

Dong Ju Kim, Marek Czosnyka, Hakseung Kim, Olivier Balédent, Piotr Smielewski, Matthew R. Garnett, Zofia Czosnyka

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Background: The dynamic relationship between pulse waveform of intracranial pressure (ICP) and transcranial Doppler (TCD) cerebral blood flow velocity (CBFV) may contain information about cerebrospinal compliance. This study investigated the possibility by focusing on the phase shift between fundamental harmonics of CBFV and ICP. Methods: Thirty-seven normal pressure hydrocephalus patients (20 men, mean age 58) underwent the cerebrospinal fluid (CSF) infusion tests. The infusion was performed via pre-implanted Ommaya reservoir. The TCD FV was recorded in the middle cerebral artery. Resulting continuous ICP and pressure-volume (PV) signals were analyzed by ICM+ software. Results: In initial stage of the CSF infusion, the phase shift was negative (median value = −11°, range = +60 to −117). There was significant inverse association of phase shift with brain elasticity (R = −0.51; p = 0.0009). In all tests, phase shift consistently decreased during gradual elevation of ICP (p = 0.00001). Magnitude of decrease in phase shift was inversely related to the peak-to-peak amplitude of ICP pulse waveform at a baseline (R = −0.51; p = 0.001). Conclusions: Phase shift between fundamental harmonics of ICP and TCD waveforms decreases during elevation of ICP. This is caused by an increase of time delay between systolic peak of flow velocity wave and ICP pulse.

Original languageEnglish
Pages (from-to)633-638
Number of pages6
JournalActa Neurochirurgica
Issue number4
Publication statusPublished - 2015


  • Cerebrospinal compliance
  • Intracranial pressure
  • Transcranial Doppler

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery


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