Purpose: To assess how intracranial pressure (ICP), intraocular pressure (IOP) and ocular perfusion pressure (OPP) differ between the morning and the afternoon in healthy subjects.
Design: Prospective pilot study.
Methods: Ten healthy subjects age 26.5 (1.2) years were included in the prospective pilot study. For each participant, blood pressure, heart rate, IOP, ICP and calculated OPP, translaminar pressure difference (TPD) were assessed two times per day, in the morning (9 ± 1 a.m.) and afternoon (2 ± 1 p.m.) by the same experienced operator. Best-corrected visual acuity and body mass index were also evaluated. TPD was calculated as IOP minus ICP. ICP was measured using a non-invasive two-depth transcranial Doppler device. P < 0.05 was considered significant.
Results: Mean ICP was higher during afternoon (10.09 (1.8) mmHg) compared to morning ICP (9.80 (2.2) mmHg), but the difference was not statistically significant (p = 0.14). By analyzing ICP according to different refractive errors categories, we found that emmetropic patients had higher ICP (morning 11.94 (3.0), afternoon 11.5 (2.6) mmHg), compared to myopic (accordingly, 9.14 (1.2) and 9.72 (1.3) mmHg) or hypermetropic (accordingly, 8.85 (0.7) and 9.17 (0.8) mmHg) patients, but the difference was not statistically significant (p > 0.05). We also found that higher OPP in the morning was correlated to lower TPD (r = -0.65; p = 0.04).
Conclusion: We found no significant variations in ICP, IOP or OPP during morning and afternoon in young healthy subjects. Higher OPP was related to lower TPD in the morning. Further prospective studies are warranted to investigate diurnal ICP variations in glaucoma patients to understand if fluctuations in ICP and TPD may contribute to the disease process.
Rodriguez-Boto G, Rivero-Garvia M, Gutierrez-Gonzalez R, Marquez-Rivas J. Basic concepts about brain pathophysiology and intracranial pressure monitoring. Neurologia. 2015;30(1):16-22.
Goel M, Picciani RG, Lee RK, Bhattacharya SK. Humor Dynamics: A Review. The Open Ophthalmology Journal. 2010;4:52-9.
[pagenumber] Samuels MA. Disturbances of cerebrospinal fluid and its circulation, including hydrocephalus, pseudotumor cerebri, and low-pressure syndromes. In: Samuels MA (eds). Adams and Victor's principles of neurology. Chapter 30, 9th ed. NY: McGraw-Hill. 2009.
Albeck MJ, Børgesen SE, Gjerris F, Schmidt JF, Sørensen PS. Intracranial pressure and cerebrospinal fluid outflow conductance in healthy subjects. J Neurosurg. 1991;74:597-600.
Smith M. Monitoring intracranial pressure in traumatic brain injury. Anesth Analg. 2008;106:240-8.
Welch K. The intracranial pressure in infants. J Neurosurg. 1980;52(5):693-9.
Leydecker WA, Neumann HG. The intraocular pressure of healthy eyes. Klin Mbl Augenheilk. 1958;133:662-70.
EGS-European Glaucoma Society. Intraocular pressure (IOP) and tonometry. In: Publicomm srl (eds). Terminology and guidelines for glaucoma. Chapter 1, 4th ed., Italy, 2014.
Yablonski M, Ritch R, Pokorny KS. Effect of decreased intracranial pressure on optic disc. Invest Ophthalmol Vis Sci. 1979;18:165.
Berdahl JP, Allingham RR, Johnson DH. Cerebrospinal fluid pressure is decreased in primary open-angle glaucoma. Ophthalmology. 2008;115:763-8.
Ren R, Wang N, Zhang X, Cui T, Jonas JB. Trans-lamina cribrosa pressure difference correlated with neuroretinal rim area in glaucoma. Graefes Arch Clin Exp Ophthalmol. 2011;249:1057-63.
Jonas JB. Role of cerebrospinal fluid pressure in the pathogenesis of glaucoma. Acta Ophthalmol. 2011;89(6):505-14.
Volkov VV. Essential element of the glaucomatous process neglected in clinical practice. Oftalmol Zh. 1976;31:500-4.
Siaudvytyte L, Januleviciene I, Ragauskas A, Bartusis L, Meiliuniene I, Siesky B, et al. The difference in translaminar pressure gradient and neuroretinal rim area in glaucoma and healthy subjects. J Ophthalmol. 2014;2014:937360.
Morgan WH, Yu DY, Cooper RL, Alder VA, Cringle SJ, Constable IJ. The influence of cerebrospinal fluid pressure on the lamina cribrosa tissue pressure gradient. Invest Ophthalmol Vis Sci. 1995;36:1163-72.
Morgan WH, Chauhan BC, Yu DY, Cringle SJ, Alder VA, House PH. Optic disc movement with variations in intraocular and cerebrospinal fluid pressure. Invest Ophthalmol Vis Sci. 2002;43:3236-42.
Zeng T, Gao L. Management of patients with severe traumatic brain injury guided by intraventricular intracranial pressure monitoring: a report of 136 cases. Chin J Traumatol. 2010;13:146-51.
Rosenberg JB, Shiloh AL, Savel RH, Eisen LA. Non-invasive Methods of Estimating Intracranial Pressure. Neurocrit Care. 2011;15(3):599-608.
Geeraerts T, Launey Y, Martin L, Pottecher J, Vigué B, Duranteau J, et al. Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury. Intensive Care Med. 2007;33:1704-11.
Siaudvytyte L, Januleviciene J, Ragauskas A, Bartusis L, Siesky B, Harris A. Update in intracranial pressure evaluation methods and translaminar pressure gradient role in glaucoma. Acta Ophthalmol 2015;93(1):9-15.
Ragauskas A, Daubaris G, Dziugys A, Azelis V, Gedrimas V. Innovative non-invasive method for absolute intracranial pressure measurement without calibration. Acta Neurochir. 2005;95:357-61.
Ragauskas A, Matijosaitis V, Zakelis R, Petrkonis K, Rastenyte D, Piper I, et al. Clinical assessment of noninvasive intracranial pressure absolute value measurement method. Neurology. 2012;78(21):1684-91.
Wilensky JT. Diurnal variations in intraocular pressure. Trans Am Ophthalmol Soc. 1991;89:757-90.
Flammer J, Orgül S, Costa VP, Orzalesi N, Krieglstein GK, Serra LM, et al. The impact of ocular blood flow in glaucoma. Prog Retin Eye Res. 2002;21:359-93.
Asrani S, Zeimer R, Wilensky J, Gieser D, Vitale S, Lindenmuth K. Large diurnal fluctuations in intraocular pressure are an independent risk factor in patients with glaucoma. J Glaucoma. 2000;9:134-42.
Wostyn P, Audenaert K, De Deyn PP. Alzheimer’s disease-related changes in diseases characterized by elevation of intracranial or intraocular pressure. Clin Neurol Neurosurg. 2008;110:101-9.
Triyoso DH, Good TA. Pulsatile shear stress leads to DNA fragmentation in human SH-SY5Y neuroblastoma cell line. J Physiol. 1999;515:355-65.
Edwards ME, Wang SS, Good TA. Role of viscoelastic properties of differentiated SH-SY5Y human neuroblastoma cells in cyclic shear stress injury. Biotechnol Prog. 2001;17:760-7.
Starcevic VP, Morrow BA, Farner LA, Keil LC, Severs WB. Longterm recording of cerebrospinal fluid pressure in freely behaving rats. Brain Res. 1988;462:112-7.
Maurel D, Ixart G, Barbanel G, Mekaouche M, Assenmacher I. Effects of acute tilt from orthostatic to head-down antiorthostatic restraint and of sustained restraint on the intra-cerebroventricular pressure in rats. Brain Res. 1996;736:165-73.
Morrow BA, Starcevic VP, Keil LC, Seve WB. Intracranial hypertension after cerebroventricular infusions in conscious rats. Am J Physiol. 1990 May;258(5 Pt 2):R1170-6.
Lin JS, Liu JKH. Circadian Variations in Intracranial Pressure and Translaminar Pressure Difference in Sprague-Dawley Rats.Invest Ophthalmol Vis Sci. 2010; 51:5739-43.
Nilsson C, Ståhlberg F, Thomsen C, Henriksen O, Herning M, Owman C. Circadian variation in human cerebrospinal fluid production measured by magnetic resonance imaging. Am J Physiol. 1992;262:R20-4.
Nilsson C, Ståhlberg F, Gideon P, Thomsen C, Henriksen O. The nocturnal increase in human cerebrospinal fluid production is inhibited by a 1-receptor antagonist. Am J Physiol. 1994;267:R1445-8.
Johanson CE, Duncan JA 3rd, Klinge PM, Brinker T, Stopa EG, Silverberg GD. Multiplicity of cerebrospinal fluid functions: New challenges in health and disease. Cerebrospinal Fluid Res. 2008;5:10.
Kropyvnytskyy IV, Saunders FW, Klemfuss H. Circadian rhythm of cerebral perfusion pressure and intracranial pressure in head injury. Brain Inj. 1999;13:45-52.
Berdahl JP, Allingham RR. Intracranial pressure and glaucoma. Curr Opin Ophthalmol. 2010;21:106-11.
Le Roux P, Menon DK, Citerio G, Vespa P, Bader MK, Brophy GM et al. Consensus summary statement of the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care: a statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine. Intensive Care Med. 2014;40(9):1189-209.
Magnaes B. Body position and cerebrospinal fluid pressure. Part 2: Clinical studies on orthostatic pressure and the hydrostatic indifferent point. J Neurosurg. 1976;44(6):698-705.
Lenfeldt N, Koskinen L, Bergenhein A, Malm J, Eklund A. CSF pressure assessed by lumbar puncture agrees with intracranial pressure. Neurology. 2007;68(2):155-8.
Ren R, Jonas JB, Tian G, Zhen Y, Ma K, Li S, et al. Cerebrospinal fluid pressure in glaucoma: a prospective study. Ophthalmol. 2010;117:259-66.
Mitchell P, Lee AJ, Wang JJ, Rochtchina E. Intraocular pressure over the clinical range of blood pressure: Blue Mountains Eye Study findings. Am J Ophthalmol. 2005;140:131-2.
Xu L, Wang H, Wang Y, Jonas JB. Intraocular pressure correlated with the arterial blood pressure: The Beijing Eye Study. Am J Ophthalmol. 2007;144:461-2.
Samuels BC, Hammes NM, Johnson PL, Shekhar A, McKinnon SJ, Allingham RR. Dorsomedial/Perifornical hypothalamic stimulation increases intraocular pressure, intracranial pressure, and the translaminar pressure gradient. Invest Ophthalmol Vis Sci. 2012;53(11):7328-35.
Durward QJ, Amacher AL, Del Maestro RF, Sibbald WJ. Cerebral and cardiovascular responses to changes in head elevation in patients with intracranial hypertension. J Neurosurg. 1983;59(6):938-44.
Magnaes B. Body position and cerebral fluid pressure. Part 1: Clinical studies on the effect of rapid postural changes. J Neurosurg. 1976;44(6):687-97.
Choi J, Jeong J, Cho HS, Kook MS. Effect of nocturnal blood pressure reduction on circadian fluctuation of mean ocular perfusion pressure: a risk factor for normal tension glaucoma. Invest Ophthalmol Vis Sci. 2006;47:831-6.
Costa VP, Harris A, Anderson D, Stodtmeister R, Cremasco F, Kergoat H et al. Ocular perfusion pressure in glaucoma. Acta Ophthalmol. 2014;92:e252-66.
Malm J, Jacobsson J, Birgander R, Eklund A. Reference values for CSF outflow resistance and intracranial pressure in healthy elderly. Neurology. 2011;76(10):903-9.
Czosnyka M, Czosnyka ZH, Whitfield PC, Donovan T, Pickard JD. Age dependence of cerebrospinal pressure-volume compensation in patients with hydrocephalus. J Neurosurg. 2001;94(3):482-6.
Fleischman D, Berdahl J, Zaydlarova J et al. Cerebrospinal fluid pressure decreases with older age. PLoS ONE 2012;7:e52664.
Fleischman D, Allingham RR, Berdahl J, Fautsch M. Body mass, spinal fluid, and glaucoma. Ophthalmology. 2011;118(6):1225-6.
Ren R, Wang N, Zhang X, Tian G, Jonas JB. Cerebrospinal fluid pressure correlated with body mass index. Graefes Arch Clin Exp Ophthalmol. 2012;250(3):445-6.
Berdahl JP, Fleischman D, Zaydlarova J, Stinnett SS, Allingham RR, Fautsch MP. Body Mass Index has a linear relationship with Cerebrospinal Fluid Pressure. Invest Ophthalmol Vis Sci. 2012;53(3):1422-7.
Gordon MO, Beiser JA, Brandt JD, Heuer DK, Higginbotham EJ, Johnson CA, et al. The Ocular Hypertension Treatment Study: baseline factors that predict the onset of primary open-angle glaucoma. Arch Ophthalmol. 2002;120:714-20.
Brandt JD, Beiser JA, Kass MA, Gordon MO. Central corneal thickness in the Ocular Hypertension Treatment Study (OHTS). Ophthalmology. 2001;108:1779-88.
Jonas JB, Stroux A, Velten I, Juenemann A, Martus P, Budde WM. Central corneal thickness correlated with glaucoma damage and rate of progression. Invest Ophthlmol Vis Sci. 2005;46:1269-74.
Loewn NA, Tanna AP. Glaucoma risc factors: Intraocular pressure. In Samples JR, Schacknow PN, ed. Clinical glaucoma care. The essentials. Chapter 1, 1st ed. Springer Link NY: Heidelberg Dordrecht London.2014.
Ragauskas A, Bartusis L, Piper I, Zakelis R, Matijosaitis V, Petrikonis K et al. Improved diagnostic value of a TCD-based non-invasive ICP measurement method compared with the sonographic ONSD method for detecting elevated intracranial pressure. Neurol Res. 2014;36(7):607-14
Killer HE, Laeng HR, Flammer J, Groscurth P. Architecture of arachnoid trabeculae, pillars, and septa in the subarachnoid space of the human optic nerve: anatomy and clinical considerations. Br J Ophthalmol. 2003;87:777-81.
Killer HE, Jaggi G, Miller NR, Flammer J, Meyer P. Does immunohistochemistry allow easy detection of lymphatics in the optic nerve sheath? J Histochem Cytochem. 2008;56(12):1087-92.
Killer HE, Miller NR, Flammer J, Meyer P, Weinreb RN, Remonda L et al. Cerebrospinal fluid exchange in the optic nerve in normal-tension glaucoma. Br J Ophthalmol. 2012;96(4):544-8.