Other

University of California

Osvaldas Pranevicius

Mindaugas Pranevicius

David S Liebeskind

Henrikas Pranevicius

Egidijus Marcinkevicius

A patient in whom blood diversion due to cerebral venous steal is present, and abolishment of the cerebral venous steal is indicated, is treated by increasing the cerebral venous pressure in the patient. This increase in cerebral venous pressure restores the collapsed cerebral vasculature, thereby increasing cerebral blood flow. The increase in cerebral venous pressure may be achieved using an occluding catheter in the superior vena cava or the internal jugular veins, using external compression of the cervical veins, or any other suitable mechanism. The occlusion may be controlled precisely during treatment, possibly as a function of cerebral blood flow, and after treatment the patient may experience a persistent effect because the cerebral vasculature is no longer collapsed.

Venous modulation of collateral perfusion of cerebral ischemia

A system for detecting and measuring increased global or local intracranial pressure includes various devices for performing controlled occlusion of jugular cranial blood outflow and generating occlusion data related to said controlled occlusion, a cranial blood outflow pressure measurement device and a processor for processing jugular cranial blood outflow occlusion data and cranial blood outflow data to identify and/or measure a functional relationship between the jugular controlled occlusion and the jugular cranial blood outflow pressure. A device communicates the functional relationship a display device and/or a patient monitoring system. The processor also detects a state of equilibrium between the jugular cranial blood outflow pressure and the jugular occlusion pressure at occlusion. In yet another embodiment, intracranial and extracranial vessel compliance is measured by NIRS system, the equilibrated using external compression bladder, and equilibrium bladder pressure is displayed as local intracranial pressure.

Noninvasive method to measure intracranial and effective cerebral outflow pressure

A method to measure effective cerebral outflow pressure or intracranial pressure is disclosed. The craniospinal venous system has multiple anastomoses between the jugular veins and vertebral venous plexus. Jugular veins collapse with cervical compression or head elevation, when extrinsic pressure exceeds venous pressure. The vertebral venous plexus is exposed to intracranial pressure and collapses when intracranial pressure exceeds venous pressure. Vertebral venous plexus is not compressed with head elevation or cervical compression, because enclosure in the spinal canal protects veins from the direct effects of atmospheric pressure and cervical compression. Using cervical compression and/or head elevation blood outflow is redistributed between jugular veins and vertebral venous plexus, while the degree of cervical compression or head elevation indicates effective cerebral outflow pressure or ICP.

Method and apparatus for detecting and treating cerebral blood vessel collapse (54) during intracranial hypertension or vasospasm by affecting cerebral venous outflow pressure (61). Venous collapse is diagnosed by lowering jugular venous bulb pressure (61) and detecting significant, progressively increasing gradient between it and ICP (60). Rising jugular venous pressure initially the collapse is terminated and then ICP starts to increase. Increasing jugular venous pressure opens collapsed vascular segments by increasing intravascular pressure. There is no increase in ICP if jugular venous pressure is maintained below value that affects ICP. During life-threatening vascular collapse caused by a plateau wave or vasospasm venous outflow pressure is temporarily increased to a level necessary to terminate collapse regardless of ICP. This is accomplished by venous occlusion catheter placed into dominant jugular vein. Catheter has highly compliant inflatable balloon operating like Starling resistor for venous outflow pressure control. Quick control of venous pressure is achieved by withdrawing/injecting fluid through catheter tip. Operation catheter is controlled by controller, which also measures ICP and possibly CBF, S.sub.jv O.sub.2. Alternative venous outflow control measures are possible.

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New York, NY, United States of America

Osvaldas Pranevicius