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Paroxysmal symptoms in intracranial hypertension, studied with ventricular fluid pressure recording and electroencephalography

, : Paroxysmal symptoms in intracranial hypertension, studied with ventricular fluid pressure recording and electroencephalography. Brain 84(3): 446-459

Continuous recordings of the eeg and ventricular fluid pressure (VFP) was carried out during 13 investigations in 6 patients suffering from intracranial tumors with increased intracranial pressure. The patients showed paroxysmal variations in VFP of the "plateau-wave" type or of the rhythmic "1-per-minute wave" type described by Lundbery (1960). The eeg was primarily abnormal in all cases. During different types of VFP variations recorded the eeg changes were in general found to be very small. There was notable absence of cortical epileptic discharges in the eeg during high plateau-waves which were accompanied by loss of consciousness and tonic-clonic convulsive movements, i.e. during attacks of the type described in the literature under such terms as "cerebellar," "mesencephalic," or "decerebrate" seizures. The paroxysmal cerebral symptoms accompanying plateau-waves in the VFP would therefore seem to originate in subcortical (probably brain-stem) structures which do not have, or are transiently disconnected from an immediate influence upon the cortical electrical activity. The present eeg observations further emphasize the difference between, on the one hand, true epileptic seizures, also occurring in cases with brain tumors, and, on the other, attacks coinciding with episodes of paroxsymal intracranial hypertension of the plateau-wave type. The onset of plateau-waves in the VFP often coincided with an arousal reaction in the behavior of the patient, as well as in the eeg. The cessation of such waves often coincided with hyperventilation and the appearance of an increased amount of slow waves in the eeg. Both arousal reactions and hyperventilation are known to be accompanied by cerebral vasomotor changes (vasodilation and vasoconstriction respectively). In cases with critical spatial conditions intracranially, such vasomotor changes could be made responsible for the initiation, respectively the cessation of plateau-waves in the VFP. The peaks of rhythmic 1-per-niinute waves in the VFP usually coincided with slight transient signs of arousal in the eeg. Such waves are synchronous with periodic breathing of the Cheyne-Stoke type and periodic variations of the systemic blood pressure.


DOI: 10.1093/brain/84.3.446

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