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NASA NTRS2007

Whole-body mathematical model for simulating intracranial pressure dynamics

A whole-body mathematical model (10) for simulating intracranial pressure dynamics. In one embodiment, model (10) includes 17 interacting compartments, of which nine lie entirely outside of intracranial vault (14). Compartments (F) and (T) are defined to distinguish ventricular from extraventricular CSF. The vasculature of the intracranial system within cranial vault (14) is also subdivided into five compartments (A, C, P, V, and S, respectively) representing the intracranial arteries, capillaries, choroid plexus, veins, and venous sinus. The body's extracranial systemic vasculature is divided into six compartments (I, J, O, Z, D, and X, respectively) representing the arteries, capillaries, and veins of the central body and the lower body. Compartments (G) and (B) include tissue and the associated interstitial fluid in the intracranial and lower regions. Compartment (Y) is a composite involving the tissues, organs, and pulmonary circulation of the central body and compartment (M) represents the external environment.

Lakin, William D.↗

NASA NTRS2010

Imaging Modalities Relevant to Intracranial Pressure Assessment in Astronauts: A Case-Based Discussion

Introduction: Intracranial pressure (ICP) elevation has been inferred or documented in a number of space crewmembers. Recent advances in noninvasive imaging technology offer new possibilities for ICP assessment. Most International Space Station (ISS) partner agencies have adopted a battery of occupational health monitoring tests including magnetic resonance imaging (MRI) pre- and postflight, and high-resolution sonography of the orbital structures in all mission phases including during flight. We hypothesize that joint consideration of data from the two techniques has the potential to improve quality and continuity of crewmember monitoring and care. Methods: Specially designed MRI and sonographic protocols were used to image eyes and optic nerves (ON) including the meningeal sheaths. Specific crewmembers multi-modality imaging data were analyzed to identify points of mutual validation as well as unique features of complementary nature. Results and Conclusion: Magnetic resonance imaging (MRI) and high-resolution sonography are both tomographic methods, however images obtained by the two modalities are based on different physical phenomena and use different acquisition principles. Consideration of the images acquired by these two modalities allows cross-validating findings related to the volume and fluid content of the ON subarachnoid space, shape of the globe, and other anatomical features of the orbit. Each of the imaging modalities also has unique advantages, making them complementary techniques.

Sargsyan, Ashot E.↗

NASA NTRS2013

Fluid Shifts Before, During, and After Prolonged Space Flight and their Association with Intracranial Pressure and Visual Impairment

With the conclusion of the Space Shuttle program, NASA is focusing on long-duration missions on the International Space Station (ISS) and future exploration-class missions beyond low Earth orbit. Visual acuity changes observed in Space Shuttle crewmembers after their short-duration missions were largely transient, but more than 30% of ISS astronauts experience more profound changes in vision, some with objective structural and functional findings such as papilledema and choroidal folds on ophthalmologic examination. Globe flattening, optic nerve sheath dilatation, optic nerve tortuosity, and other findings have been noted in imaging studies. This pattern is referred to as visual impairment and intracranial pressure (VIIP) syndrome. The VIIP signs and symptoms, as well as postflight lumbar puncture data, suggest that elevated intracranial pressure (ICP) is associated with the space flight-induced cephalad fluid shifts, but this hypothesis has not been systematically tested. The purpose of this study is to objectively characterize the fluid distribution and compartmentalization associated with long-duration space flight, and to correlate the findings with vision changes and other elements of the VIIP syndrome. We also seek to determine whether the magnitude of fluid shifts during space flight, as well as the VIIP-related effects of those shifts, can be predicted by crewmember baseline data and responses to acute hemodynamic manipulations (such as head-down tilt tests) obtained before flight. Lastly, we will evaluate the patterns of fluid distribution in astronaut subjects on the ISS during the use of lower body negative pressure (LBNP) and respiratory maneuvers to characterize and explain general and individual responses during space flight.

Stenger, M.↗

NASA NTRS1978

Telemetry of intracranial pressure

A completely implantable epidural pressure telemetry system designed for accurate measurement of intracranial pressure (ICP) is described. The implant device is batteryless, providing unlimited operating life. The described system uses a capacitive pressure transducer with excellent long-term stability. Once detected with the transducer and converted to a frequency with the oscillator electronics, the pressure signal is digitized. It is then telemetered without the possibility of further degradation. After detection with the small external module, the data can be retransmitted by a radio link for complete patient mobility or the energizer signal pickup module can be wired to a bedside readout unit. Continuous data are available from the system so that the dynamic ICP changes reflecting arterial blood pressure can be observed and used for diagnosis.

Fryer, T. B.↗

NASA NTRS2002

Method and Apparatus for Assessment of Changes in Intracranial Pressure

A non-invasive method and apparatus for monitoring changes in intracranial pressure which removes extracranial effects from the measurements. The method and apparatus can include the supplying of a fixed frequency electrical output to a transducer coupled to the patient's head, thereby generating an acoustical tone burst in the patient's head which generates a first echo and a second echo, the first echo reflecting from a first interface in the side of the patient's head coupled to the transducer, and the second echo reflecting from a second interface at the opposite side of the patient's head. The first and second echoes are received by the transducer which can generate a first electrical signal and a second electrical signal, wherein the first and second electrical signals vary in accordance with the corresponding first and second echoes. The counterbalancing phase shifts required to bring about quadrature between each of the first and second electrical signals and the fixed frequency electrical output can be measured, and values for the change in intracranial distance based on the changes in the counterbalancing phase shifts can be obtained.

Yost, William T.↗

NASA NTRS1997

Postural Effects on Intracranial Pressure as Assessed Noninvasively

This study was designed to investigate effects of whole body tilting on intracranial compliance and pressure in six healthy volunteers by using a noninvasive ultrasonic device. Subjects were randomly tilted up or down sequentially at 60 degree, 30 degree head-up, supine, and 15 degree head-down position for one minute at each angle. We measured arterial blood pressure with a finger pressure cuff and changes in intracranial distance with an ultrasonic device. The device measures skull movement on the order of micro-meter. Our ultrasound technique demonstrates that skull movement is highly correlated (r$(circumflex){2}$=0.77) with intracranial pressure variations due to cerebral arterial pulsation. The amplitudes of arterial pressure (r$(circumflex){2}$=0.99 and those of intracranial distance changes (r$(circumflex){2}$=0.87) associated with one cardiac cycle were inversely correlated with the angle of tilt. The ratio of pulsation amplitudes for intracranial distance over arterial pressure also showed a significant increase as the angle of tilt was lowered (p=0.003). Thus, postural changes alter intracranial compliance in healthy volunteers and intracranial volume-buffering capacity is reduced in head-down position.

Ueno, Toshiaki↗

NASA NTRS2011

Risk of Microgravity-Induced Visual Impairment and Elevated Intracranial Pressure (VIIP)

Eight cases identified, represent 23.5% of the 34 crewmembers flown on the ISS, with inflight visual changes and pre-to-postflight refractive changes. In some cases, the changes were transient while in others they are persistent with varying degrees of visual impairment. (1) Decreased intraocular pressure (IOP) postflight was observed in 3 cases. (2) Fundoscopic exams revealed postflight findings of choroidal folds in 4 cases, optic disc edema in 5 cases and presence of cotton wool spots in 3 cases. (3) Optical coherence tomography (OCT) confirmed findings of choroidal folds and disc edema and documented retinal nerve fiber layer thickening (4 cases). (4) Findings from MRI examinations showed posterior globe flattening (5 cases) and optic nerve sheath distension (6 cases). (5) Opening cerebrospinal fluid (CSF) pressure was elevated in 4 cases postflight reflecting raised intracranial pressure. While the etiology remains unknown, hypotheses speculate that venous insufficiency or hypertension in the brain caused by cephalad fluid shifts during spaceflight are possible mechanisms for ocular changes in astronauts.

Otto, Christian↗

NASA NTRS1994

Measuring Intracranial Pressure And Volume Noninvasively

Ultrasonic technique eliminates need to drill into brain cavity. Intracranial dynamics instrument probes cranium ultrasonically to obtain data for determination of intracranial pressure (ICP) and pressure-volume index (PVI). Instrument determines sensitivity of skull to changes in pressure and by use of mechanical device to exert external calibrated pressure on skull. By monitoring volume of blood flowing into jugular vein, one determines change of volume of blood in cranial system. By measuring response of skull to increasing pressure (where pressure increased by tilting patient known amount) and by using cranial blood pressure, one determines intial pressure in cerebrospinal fluid. Once PVI determined, ICP determined.

Cantrell, John H.↗

NASA NTRS1998

Intracranial pressure dynamics during simulated microgravity using a new noninvasive ultrasonic technique

It is believed that intracranial pressure (ICP) may be elevated in microgravity because a fluid shift toward the head occurs due to loss of gravitational blood pressures. Elevated ICP may contribute to space adaptation syndrome, because as widely observed in clinical settings, elevated ICP causes headache, nausea, and projectile vomiting, which are similar to symptoms of space adaptation syndrome. However, the hypothesis that ICP is altered in microgravity is difficult to test because of the invasiveness of currently-available techniques. We have developed a new ultrasonic technique, which allows us to record ICP waveforms noninvasively. The present study was designed to understand postural effects on ICP and assess the feasibility of our new device in future flight experiments.

NASA Center ARC↗

NASA NTRS1994

Noninvasive Intracranial Pressure and Tissue Oxygen Measurements for Space and Earth

The paper discusses the following: Increasing intracranial pressure in humans during simulated microgravity. and near-infrared monitoring of model chronic compartment syndrome in exercising skeletal muscle. Compared to upright-seated posture, 0 deg. supine, 6 deg. HDT, and 15 deg. HDT produced TMD changes of 317 +/- 112, 403 +/- 114, and 474 +/- 112 n1 (means +/- S.E.), respectively. Furthermore, postural transitions from 0 deg. supine to 6 deg. HDT and from 6 deg. to 15 deg. HDT generated significant TMD changes (p less than 0.05). There was no hysteresis when postural transitions to HDT were compared to reciprocal transitions toward upright seated posture. Currently, diagnosis of chronic compartment syndrome (CCS) depends on measurement of intramuscular pressure by invasive catheterization. We hypothesized that this syndrome can be detected noninvasively by near-infrared (NIR) spectroscopy, which tracks variations in muscle hemoglobin/myoglobin oxygen saturation. CCS was simulated in the tibialis anterior muscle of 7 male and 3 female subjects by gradual inflation of a cuff placed around the leg to 40 mmHg during 14 minutes of cyclic isokinetic dorsiflexion exercise. On a separate day, subjects underwent the identical exercise protocol with no external compression. In both cases, tissue oxygenation (T(sub O2) was measured in the tibialis anterior by NIR spectroscopy and normalized to a percentage scale between baseline and a T(sub O2) nadir reached during exercise to ischemic exhaustion. Over the course of exercise, T(sub O2) declined at a rate of 1.4 +/- 0.3% per minute with model CCS, yet did not decrease during control exercise. Post-exercise recovery of T(sub O2) was slower with model CCS (2.5 +/- 0.6 min) than in control (1.3 +/- 0.2 min). These results demonstrate that NIR spectroscopy can detect muscle deoxygenation caused by pathologically elevated intramuscular pressure in exercising skeletal muscle. Consequently, this technique shows promise as a noninvasive diagnostic tool for CCS.

Hargens, A. R.↗

NASA NTRS1997

Non-Invasive Measurement of Intracranial Pressure Pulsation using Ultrasound

Exposure to microgravity causes a cephalad fluid shift which may elevate intracranial pressure (ICP). Elevation in ICP may affect cerebral hemodynamics in astronauts during space flight. ICP is, however, a difficult parameter to measure due to the invasiveness of currently available techniques. We already reported our development of a non-invasive ultrasound device for measurement of ICP. We recently modified the device so that we might reproducibly estimate ICP changes in association with cardiac cycles. In the first experiment, we measured changes in cranial distance with the ultrasound device in cadavera while changing ICP by infusing saline into the lateral ventricle. In the second experiment, we measured changes in cranial distance in five healthy volunteers while placing them in 60 deg, 30 deg head-up tilt, supine, and 10 deg head-down tilt position. In the cadaver study, fast Fourier transformation revealed that cranial pulsation is clearly associated with ICP pulsation. The ratio of cranial distance and ICP pulsation is 1.3microns/mmHg. In the tilting study, the magnitudes of cranial pulsation are linearly correlated to tilt angles (r=0.87). The ultrasound device has sufficient sensitivity to detect cranial pulsation in association with cardiac cycles. By analyzing the magnitude of cranial pulsation, estimates of ICP during space flight are possible.

Ueno, Toshiaki↗

NASA NTRS1994

Non-invasive method and apparatus for monitoring intracranial pressure and pressure volume index in humans

Non-invasive measuring devices responsive to changes in a patient's intracranial pressure (ICP) can be accurately calibrated for monitoring purposes by providing known changes in ICP by non-invasive methods, such as placing the patient on a tilting bed and calculating a change in ICP from the tilt angle and the length of the patient's cerebrospinal column, or by placing a pressurized skull cap on the patient and measuring the inflation pressure. Absolute values for the patient's pressure-volume index (PVI) and the steady state ICP can then be determined by inducing two known changes in the volume of cerebrospinal fluid while recording the corresponding changes in ICP by means of the calibrated measuring device. The two pairs of data for pressure change and volume change are entered into an equation developed from an equation describing the relationship between ICP and cerebrospinal fluid volume. PVI and steady state ICP are then determined by solving the equation. Methods for inducing known changes in cerebrospinal fluid volume are described.

Cantrell, John H.↗

NASA NTRS1997

Non-invasive method and apparatus for monitoring intracranial pressure and pressure volume index in humans

Yost, William T.↗

NASA NTRS1979

Remotely-powered intracranial pressure monitor

Implantable RF powered monitor uses capacitive transducer and stiff metal diaphragm that gives high stability for long term intracranial pressure monitoring. Design of monitor reduces risk of infection while improving patient comfort and mobility.

Fryer, T. B.↗

NASA NTRS2022

Noninvasive Indicators of Intracranial Pressure Before, During, and After Long-Duration Spaceflight

Weightlessness induces a cephalad shift of blood and cerebrospinal fluid that may increase intracranial pressure (ICP) during spaceflight, while lower body negative pressure (LBNP) may provide an opportunity to caudally redistribute fluids and lower ICP. To investigate the effects of spaceflight and LBNP on noninvasive indicators of ICP (nICP), we studied thirteen crewmembers before and after spaceflight in seated, supine, and 15° head-down tilt postures, and at ~45 and ~150 days of spaceflight with and without 25 mmHg LBNP. We used 4 techniques to quantify nICP: cerebral and cochlear fluid pressure (CCFP), otoacoustic emissions (OAE), ultrasound measures of optic nerve sheath diameter (ONSD), and ultrasound-based internal jugular vein pressure (IJVp). On flight day 45, two nICP measures were lower than preflight supine posture (CCFP: mean difference -98.5 -nl [CI: -190.8 to -6.1 -nl], p = 0.037]; OAE: -19.7 degrees [CI: -10.4 to -29.1 degrees], p < 0.001), but not significantly different from preflight seated measures. Conversely, ONSD was not different than any preflight posture, whereas IJVp was significantly greater than preflight seated measures (14.3 mmHg [CI: 10.1 to 18.5mmHg], p < 0.001), but not significantly different than preflight supine measures. During spaceflight, acute LBNP application did not cause a significant change in nICP indicators. These data suggest that during spaceflight nICP is not elevated above values observed in the seated posture on Earth. Invasive measures would be needed to provide absolute ICP values and more precise indications of ICP change during various phases of spaceflight.

Jessica V. Jasien↗

NASA NTRS2010

Noninvasive Techniques for Intracranial Pressure Assessment: A Review from Aerospace Medicine Perspective

Microgravity-induced changes in fluid distribution and other physiological factors due to space flight have been implicated as the cause of increased intracranial pressure (ICP) in a number of space crewmembers. The modest levels of ICP elevation and absence of severe symptoms in this group do not warrant invasive diagnostic interventions. However, the long-term trends and residual or consequential changes secondary to the observed ICP elevation in this group are not yet known. Therefore, close attention is needed to evaluate the potential techniques of noninvasively assessing ICP, including those feasible for in-flight use. Of particular interest is continuity between ground and in-flight testing, whereby data from the same or different techniques allow reasonably dependable estimation of ICP trends and responses. Methods: A thorough review of current literature, analysis of NASA data, and interviews with subject matter experts were conducted to construct a presentation that reflects the state of the art for noninvasive ICP measurement and monitoring. Results: Multiple imaging and non-imaging modalities are available to assess ICP in terrestrial clinical and experimental environments. Imaging alternatives include magnetic resonance imaging (MRI) and high-resolution sonography. Non-imaging techniques include transcranial Doppler, certain audiological methods, and venous ophthalmodynamometry, among others. Special functional techniques have been proposed recently that allow the use of advanced MRI methods to calculate ICP in addition to the acquisition of high-resolution images. Our data include many of these applications, with several cases of correlation with lumbar puncture, the invasive "gold standard" measurement of ICP.

Hamilton, Douglas R.↗

NASA NTRS2014

Fluid Shifts Before, During and After Prolonged Space Flight and Their Association with Intracranial Pressure and Visual Impairment

Future human space travel will primarily consist of long duration missions onboard the International Space Station or exploration class missions to Mars, its moons, or nearby asteroids. Current evidence suggests that long duration missions might increase risk of permanent ocular structural and functional changes, possibly due to increased intracranial pressure resulting from a spaceflight-induced cephalad (headward) fluid shift.

Stenger, Michael↗

NASA NTRS2012

NASA's Current Evidence and Hypothesis for the Visual Impairment and Intracranial Pressure Risk

While 40 years of human spaceflight exploration has reported visual decrement to a certain extent in a subgroup of astronauts, recent data suggests that there is indeed a subset of crewmembers that experience refraction changes (hyperoptic shift), cotton wool spot formation, choroidal fold development, papilledema, optic nerve sheath distention and/or posterior globe flattening with varying degrees of severity and permanence. Pre and postflight ocular measures have identified a potential risk of permanent visual changes as a result of microgravity exposure, which has been defined as the Visual Impairment and Intracranial Pressure risk (VIIP). The combination of symptoms are referred to as the VIIP syndrome. It is thought that the ocular structural and optic nerve changes are caused by events precipitated by the cephalad fluid shift crewmembers experience during long-duration spaceflight. Three important systems, ocular, cardiovascular, and central nervous, seem to be involved in the development of symptoms, but the etiology is still under speculation. It is believed that some crewmembers are more susceptible to these changes due to genetic/anatomical predisposition or lifestyle (fitness) related factors. Future research will focus on determining the etiology of the VIIP syndrome and development of mechanisms to mitigate the spaceflight risk.

Otto, Christian A.↗