Critical closing pressure (CrCP) is the arterial blood pressure (ABP) threshold, below which small arterial vessels collapse and cerebral blood flow ceases. Here we aim to compare three methods for CrCPestimation in scenario of a controlled increase in intracranial pressure (ICP), induced by infusion tests performed in patients with suspected normal pressure hydrocephalus (NPH). METHODS: Computer recordings of directly-measured ICP, ABP and transcranial Doppler cerebral blood flow velocity (CBFV), from 37 NPH patients undergoing infusion tests, were retrospectively analyzed. The CrCP was calculated with three methods: one with the first harmonics ratio of the pulse waveforms of ABP and CBFV (CrCPA) and two methods based on a model of cerebrovascular impedance, as functions of both cerebral perfusion pressure (CrCPinv), and of ABP (CrCPninv). CONCLUSION: All methods give similar results in response to ICP changes. In the case of individual CrCP measurements for each patient, CrCPA may provide negative, non-physiological values. Invasive critical closing pressure is most sensitive to variations in ICP and CPP and can be used as an indicator of the cerebrospinal and the cerebrovascular system status during infusion tests.This study was partially supported by the statutory fund of the Mossakowski Medical Research Centre Polish Academy of Sciences and Institute of Electronic Systems, Warsaw University of Technology. Katarzyna Kaczmarska was also supported by the European Union in the framework of the European Social Fund through the Warsaw University of Technology Development Programme
