Application of non-invasive brain physiological measurement technologies
• Traumatic brain injury. A key objective after traumatic brain injury is the prevention of secondary insults caused by swelling of injured brain tissue. Because the brain is encased by the rigid skull, tissue swelling leads to raised ICP, which in turn reduces blood flow, and can lead onto the risk of brain damage and death.
• Stroke strikes 500,000 Americans every year (1). When these patients arrive at emergency rooms, clinicians rely on the current standard of care, a CT scan, to diagnose and treat increased brain swelling or bleeding. While this can take 45 – 120 minutes, non-invasive ICP technology can diagnose swelling or bleeding by measuring ICP faster, safer, and more cost effectively than a CT, reducing the time to treatment and improving patient outcomes.
• Hydrocephalus is a life threatening disease caused by a dangerous build up of excess cerebrospinal fluid (CSF) in the brain. The mainstay of treatment for these patients is a surgical procedure for CSF diversion, most commonly a ventricular-peritoneal shunt. In 2000 in the US, there were 7.5 million hydrocephalus patient admissions (2). Up to 80% of CSF shunts block within 2 years of insertion, but determination of shunt blockage can only be made using clinical assessment. ICP measurement is needed to distinguish between benign conditions, such as the flu, and hydrocephalus caused by shunt failure. Non-invasive ICP technology solves this problem by quickly measuring ICP in a safe manner.
• Brain Tumor is a malignant mass pressing on the patient’s brain within the rigid skull. An estimated 90,000 Americans live with a diagnosis of brain tumor (3). When these patients arrive at emergency rooms, clinicians must quickly determine if the patient is suffering from brain swelling caused by the tumor. Non-invasive ICP technology can identify swelling or bleeding by measuring ICP faster, safer, and more cost effectively than a CT or MRI, reducing the time to treatment and improving patient outcomes.
• Chronic persistently elevated ICP e.g. idiopathic intracranial hypertension (IIH) is a disease that causes blindness and headaches. This disease affects approximately 10-20 of every 100,000 persons, or about 30,000 Americans per year. Currently, increased ICP caused by IIH can only be diagnosed via an invasive lumbar puncture. Non-invasive ICP technology is able to do diagnosis of IIH by measuring ICP faster, safer, and more cost effectively than an invasive spinal tap, reducing patient discomfort and improving patient outcomes.
• Meningitis is a clinical syndrome characterized by inflammation of the meninges. It is life-threatening disease because of the inflammation's proximity to the brain and spinal cord. One of the important component or complication of meningitis is the development of increased intracranial pressure . Non-invasive measurement of ICP would be certainly beneficial for meningitis diagnosis and treatment.
• Metabolic Encephalopathy - is temporary or permanent damage to the brain. The most common cause is an illness or condition that affects the liver. Toxins build up in the bloodstream because the liver is not working normally, what can cause raised ICP (4).
• Brain Surgery is performed on over 104,000 Americans each year (5). Brain Surgery puts patients at risk for swelling of the brain, leading to increased ICP that can cut off the blood flow to the brain. Non-invasive ICP technology offers an ideal non-invasive way to monitor the ICP of these patients both in the operating room and during recovery as a means of preventing brain damage and improving patient outcomes.
• Battlefield traumatic brain injury. The US Army’s Combat Casualty Care Research Program (CCCRP) lists head trauma as the second leading cause of combat death. According to Dr. Kenneth Curley, Director of the US Army’s Telemedicine and Advanced Technology Research Center (TATRC), the military is actively seeking a portable, durable ICP diagnostic device so that first responders can diagnose combat casualties with elevated ICP and initiate a treatment plan in the field. With fewer than half of soldiers with TBI identified and evaluated in the field (6), faster ICP diagnosis would facilitate triage for faster evacuation to a neurosurgery-equipped field hospital.
The wide range of possible applications of brain monitoring technologies may expand even further due to non-invasive nature of the devices.
• Cardiac surgeries that require a heart-lung machine place patients at risk for altered blood flow dynamics and mini-strokes that decrease oxygen flow to the brain. A brain that lacks proper oxygenation swells, leading to increased ICP. Vittamed’s noninvasive ICP technology will serve as a potentially life saving monitor by reducing stroke for the 628,000 patients who undergo open heart surgery every year.
• Sports medicine, aero-cosmic medicine, drug research and other research fields. Non-invasive technologies open up possibility to find answers to questions which could not be answered with invasive technologies. 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. The impaired cerebral autoregulation for cosmonauts and sportsmen under physical load may have consequences leading to serious health problems.
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1 Cowan WM, Kandel ER. Prospects for neurology and psychiatry. Jama 2001;285(5):594-600.
2 Patwardhan RV, Nanda A. Implanted ventricular shunts in the United States: the billion-dollar-a-year cost of hydrocephalus treatment. Neurosurgery 2005;56(1):139-44.
3 Gurney JG et al. Brain and other central nervous system tumors: rates, trends, and epidemiology. Current Opinion in Oncology. 13(3):160-6, 2001 May.
4 R. Ravi, R.J.Morgan, Intracranial pressure monitoring Current Anaesthesia & Critical Care (2003) 14, 229--235.
5 Gurney JG et al. Brain and other central nervous system tumors: rates, trends, and epidemiology. Current Opinion in Oncology. 13(3):160-6, 2001 May.
6 USA Today, July 24, 2008.