Influence of systemic and cerebral vascular factors on the cerebrospinal fluid pulse waves.

ABSTRACT

In anesthetized, artificially ventilated dogs, the intracranial cerebrospinal fluid (CSF) pulse waves were studied simultaneously with the central aortic pressure, central venous pressure (CVP), and the sagital sinus pressure under physiological conditions and in normovolemic arterial hypotension and hypertension, in acute cardiac insufficiency of the right atrium, in raised intracranial pressure (ICP), and in arterial hypoxemia. The physiological CSF pulsations are shown to be mainly arterial in origin. In the diastolic phase, the descending part of the pulse curve can be modified by venous superpositions coinciding with the right atrial "A" wave. With increase of ICP the configuration of the CSF pulsations changes the venous superpositions disappear and the waves become more and more arterial in shape. Furthermore, the pulse amplitude increases considerably. The same change can be observed when cerebral vessels are dilated by arterial hypoxemia. During cardiac insufficiency and consecutive increase of CVP, the CSF pulse curve is venous in shape and the right atrial "A" wabe predominates. In arterial hypotension, CSF pressure decreased. Conversely, in angiotensin-induced systemic arterial hypertension, CSF pressure and its pulse amplitude increased. It is concluded that both systemic arterial blood pressure and cerebrovascular reactivity are major determinants for the shape and the pressure amplitude of the intracranial CSF pulse waves. In the presence of cerebral vasodilatation, systemic arterial blood pressure may be an important factor in raising ICP and altering the brain tissue compliance, because cerebral vascular damping of the arterial pulse is diminished and the arterial pressure head may be directly transmitted to the cerebral capillary bed.