Abstract
Some substantial number of unfortunate patients suffer from the symptoms and signs of elevated cerebrospinal fluid (CSF) pressure, even though pressure measured in the cerebral venous system is normal. We hypothesize that, with elevated CSF pressure, cerebral microvascular congestion may occur, even though (subdural) large-vein pressure has been shown to be normal.
Highlights
Some substantial number of unfortunate patients suffer from the symptoms and signs of elevated cerebrospinal fluid (CSF) pressure, even though pressure measured in the cerebral venous system is normal
Even with elevated CSF pressure, large-vein pressure could be normal because the large veins are “tented” open by their structural relation to the dura
By this “Starling-resistor” action, venular and microvascular pressure would have to increase if flow were to continue. This increased microvascular pressure might be measured by an adaptation of cardiologists’ wedge-pressure logic. (When an artery is obstructed by a catheter or by the inflation of a balloon, the pressure measured in the stationary column of blood beyond the obstruction is equal to the downstream pressure.). Experimental verification of this hypothesized mechanism has been impeded by the presence of an arterial rete in many species other than in dogs or in human subjects and dogs have been unavailable to us
Summary
Some substantial number of unfortunate patients suffer from the symptoms and signs of elevated cerebrospinal fluid (CSF) pressure, even though pressure measured in the cerebral venous system is normal. With elevated CSF pressure, cerebral microvascular congestion may occur, even though (subdural) largevein pressure has been shown to be normal
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