ICP Waves

The ICP wave is produced by pressure transmitted from the arterial pulse to the brain.  This wave has 3 components:

  1. P1 – percussion (systolic) wave – produced by systolic pressure transmitted to choroid plexus and is the mechanism by which CSF is produced
  2. P2 – elastance (tidal) wave – produced by the restriction of ventricular expansion by the rigid dura and scull, like an echo
  3. P3 – dicrotic wave – produced by closure of the aortic valve

2015-06-12 16.09.18

Normal ICP wave:  P1 has the highest pulse pressure, followed by P2 and P3.

In disturbed intracranial elastance (i.e. small increases in intracranial volume dramatically increases ICP), P2 pulse pressure is higher than P1.

Another picture to illustrate normal and noncompliant ICP waveforms.  


LUNDBERG WAVES
Lundberg A (Plateau) waves are periodic, sustained increase in ICP (>50mmHg) for 15 minutes or more, and is associated with poor intracranial compliance and poor prognosis.

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Lundberg B waves are periodic, self-limited increases in ICP (20-50mmHg) occuring every 1-2 minutes and lasting several seconds.

Lundberg C waves are periodic, self-limited increases in ICP (~20mm Hg) occuring every 4-8 inutes.  Significance of these waves are unknown.

 

 

 

References

Bhardwaj, Anish, and Marek Alexander Z Mirski. Handbook Of Neurocritical Care. New York: Springer, 2010. Print.

Clinicalgate.com,. “Principles Of Neurointensive Care | Clinical Gate”. N.p., 2016. Web. 10 Feb. 2016.

Rahaman, Ubaidur, Ubaidur Rahaman, and Ubaidur Rahaman. “Learning Critical Care Medicine: June 2015”. Learningcriticalcaremedicine.blogspot.com. N.p., 2015. Web. 10 Feb. 2016.

Tasneem, Nudrat et al. “Brain Multimodality Monitoring: A New Tool In Neurocritical Care Of Comatose Patients”. Critical Care Research and Practice 2017 (2017): 1-8. Web.

Kiwon Lee, NeuroICU Book.

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