Method and device for determining the pressure inside the brain

 

The invention relates to medical equipment, namely, devices for measuring intracranial pressure non-invasive method using ultrasonic Doppler device which measures the speed of blood flow within the ophthalmic artery as in intracranial and veneciano area of the ophthalmic artery. Eyes which see the blood flow, is subjected to a small pressure sufficient to align the results of measurements of blood flow in the internal and external areas of the ophthalmic artery. A device for determining intracranial pressure includes an inflatable bladder and an ultrasonic transducer with an acoustic pulse transmitter and receiver, while the signal for the control circuit depth with depth regulator metering selection signals, frequency counter samples with memory, connected to the block for determining a frequency shift from the frequency of the transmitted pulse. To increase the pressure in the inflatable chamber to block the increase in pressure is the pump. Ultrasonic transducer, and the second made with the possibility of adjusting the position of the Central axis of the correction pulses on internal and external Castagnoli. 3 S. and 6 C.p. f-crystals, 5 Il.

The technical field This invention relates in General to a method and apparatus for ultrasonic determination of intracranial pressure, and more narrowly refers to a method and apparatus for determining intracranial pressure using ultrasonic velocity measurements of blood flow through the ophthalmic artery.

The prior art In U.S. patent 4907595 described a device for determining the pressure and flow inside of the ophthalmic artery. The device used a tough camera that can tightly attach to the human eye so as to create pressure in order to apply external pressure to the eyeball. The camera has also established an ultrasonic transducer and oriented so as to direct ultrasonic pulses for Doppler flow measurements within the ophthalmic artery. The device works in such a way that the operator has the ability to increase the pressure to a level at which the blood flow through the ophthalmic artery stops. The pressure at which this occurs is an indication of the pressure inside of the ophthalmic artery. A typical value of the pressure at which this event occurs, in point what it is the pressure necessary for carrying out the required measurements is so large that it significantly exceeds the maximum recommended in General practice values. If such a device is used for a long time may develop tissue damage, and this can lead to an increase in intracranial pressure PICto an unacceptable level.

Another ultrasonic device for determining changes in intracranial pressure in the skull of the patient described in U.S. patent 5117835 and based on the fact that a pair of ultrasonic transducers are placed on the skull, and the received signals are registered. In U.S. patent 4984567 described device for measuring intracranial pressure by means of ultrasonic transducer based on acoustic reflections caused by the ultrasonic pulses. Other patents related to ultrasonic measurement of intracranial pressure or other physiological parameters: 4204547, 4930513, 50116641 and 5040540.

The prior art does not provide clear and unequivocal evidence of intracranial pressure. There is a tendency to noise distortion measurements associated with the uncertainty in the measurements. Therefore, there is a need to provide hair would be to implement with sufficient degree of reliability.

Brief description of the invention using the device of the invention, it is possible to obtain an indication of the pressure inside the skull is a non-invasive method using the ultrasonic Doppler measurements, which apply to the human eye in a secure manner.

This is achieved through the use of the method of the invention, which increases the pressure in the chamber, hermetically parts which come into contact with the perimeter of the eye, and use ultrasonic Doppler measuring device mounted on the camera, to measure the internal and external flow velocity in intracranial and veneciano areas of the ophthalmic artery. Signals corresponding to these measurements of velocity V1and V2compared, and their differenceV is used to control the pressure in the chamber. When the pressure in the chamber causesV reaches the desired minimum value, this pressure becomes the indication of intracranial pressure.

When using the device and method in accordance with this invention to the eye put significantly less pressure than in the case of the above patent 4907595. Typical rum avoid tissue damage and pain.

The method in accordance with this invention may be embodied in various ways, such as manual zoom and control the pressure applied to the camera, for observing internal signals and external velocities determined ultrasonic Doppler device. When the results of these measurements will be almost the same, the pressure at which this occurs is used to determine the intracranial pressure.

Alternatively, by way of ultrasonic Doppler velocity measurements in accordance with this invention the difference of measurements of velocities in the Central retinal arteryV can be used to directly control the pressure in the chamber by feeding the signal to the pump. The value of the pressure signal corresponding to pressure in the chamber can be used to store the signal in a suitable memory device and to display an indicator of intracranial pressure.

Another aspect of the invention allows measurement of the pulse or the dynamic characteristics of the area within the skull, if the instrument is described in U.S. patent 5388583, the data must be converted to the form of the absolute measurement is STV for determining intracranial pressure using non-invasive ultrasound techniques which is solved by the fact that according to the invention the chamber is inflatable, acoustic pulse transmitter through the valve is connected to the receiver, which is configured to output bus output signal to the control circuit depth is made with the possibility of the formation of successively through the depth regulator metering signals select "internal" and "external" through the respective outputs of logical And gates, and the element OR connected to the frequency counter samples associated with the memory connected to the block for determining the frequency shift from the frequency of the transmitted pulse, increasing the pressure in the inflatable chamber unit increase pressure pump connected to the pump, while the pressure transducer is a pressure sensor inside the chamber and configured to generate a signal intracranial pressure.

It is desirable that the block determine the differenceV to determine the intracranial pressure was made with the ability to display its internal reference VIand external VEvelocity of blood corresponding frequency shift in the definition block of the frequency shift.

It is desirable to additionally had BSCI controller, containing block comparing the differenceV andVminassociated with a unit increase of the pressure pump and the block storing indications of intracranial pressure.

Another objective behind the creation of this invention is a device for obtaining indications of blood flow within the ophthalmic artery, which comes from the inside of the skull of the body in the eyes of the body, which is solved by the fact that according to the invention the chamber is inflatable, with application of pressure on the ophthalmic artery and installation of the ultrasonic transducer, which is made with the possibility of adjusting the position of the Central axis direction of the ultrasonic pulses in the internal and external area of the ophthalmic artery, the acoustic pulse transmitter through the valve is connected to the receiver, configured to output bus output signal to the control circuit depth, made with the possibility of the formation of successively through the depth regulator metering signals select "internal" and "external" through the respective outputs of logical And gates and the OR element connected to the frequency counter samples associated with pamatyti blood in the ophthalmic artery.

Preferably, the ultrasonic transducer was made with the possibility of adjusting the position of the Central axis direction of the ultrasonic pulses, both internal and external area of the ophthalmic artery, determining the spatial angle1that is the maximum level of the Doppler signal at the internal site and the spatial angle2, wherein the maximum pulsation Doppler signal on the external area of the ophthalmic artery and selecting the operational direction of the axis of the transducer along the median between the angles1and2while the depth regulator metering is performed with the possibility of consecutive measurements of blood flow velocity within the inner and outer sections of the ophthalmic artery.

Preferably, in order to inflatable chamber flexible tube, through the valve was connected to a hand pump, and the tube was connected with a pressure indicator for its image in visual and/or digital form.

It is desirable that the device be equipped with a display.

Another problem solved by this invention, the two who Lesnoy artery according to which change the angle of the Central axis of the transducer, determine the speed at the outer area of the ophthalmic artery on the maximum level of the Doppler signal at the internal area _ by the maximum pulsation Doppler signal and receive their difference, then change the external pressure on the eye to the level at which the differential value falls below the minimum level and receive an indication of intracranial pressure.

It is desirable that the testimony of intracranial pressure were reflected on the display.

These and other advantages and objectives of the invention will become clear after reading the following description of several variants of embodiment of the invention with drawings.

A brief description of the drawings Fig.1 is a schematic and block diagram of the device in accordance with this invention; Fig.2 is a perspective view of installation of the device in accordance with this invention on the skull of a patient; Fig.3 is a simplified schematic and block diagram to illustrate the invention; Fig. 4 - sequence of operation for the device depicted in Fig.1; and Fig. 5 - plots of the velocity of flow V, ripple internal and external areas of the ophthalmic artery is with the invention it is possible to determine the internal pressure inside the head of a person using the monitoring of blood flow velocity within the ophthalmic artery. This requires ultrasonic device or instrument capable of applying a slight pressure on the eye, in order to equalize the internal and external flow in the ophthalmic artery, leading to the eye. This type of measurement is possible that demonstrates the following analysis.

Calculation of the coefficient Reynolds ophthalmic artery of the retina has the form:

Since Re<<2000, this means that the flow is laminar.

The average speed of the flow inside the ophthalmic artery HA does not depend on the distance from intracranial Central carotid artery, but depends on the cross-sectional area HA and blood flow within it.

The influence of the pulsating nature of the flow changes the flow profile. The period T of pulsatile blood flow is equal to the period of the pulsations of the heart (approximately one second). Prismera frequency W is equal to:

where DI- inner diameter of the ophthalmic artery HA, and the velocity profile of blood in HA parabolic:

where DEthe outer diameter of the section HA, VE- blood flow velocity of the external plot HA, VI- blood flow velocity inside HA.

The thread F is directly proportional to the mean velocity of blood VE=DI.

4. If the Central pressure of the carotid artery is equal to RISAand the pressure inside the outer area HA is equal to ROAU(Fig.1), the pressure gradientPbetween two points of measurement of the flow velocity (Fig.1) can be found from the equation:
PAOE= PISA-P(5)
and

From equation (6) implies that the value ofPsmall compared with the measured value of the intracranial pressure PICand they can be neglected or approximated offset as a measurement error.

5. The balance of pressures. Balances the pressure in the internal measurement point can be expressed as follows:
PATM+PIC+PAWI=PMCA, (7)
where PICintracranial pressure PATM- atmospheric pressure, and PAWIthe pressure of the arterial wall.

The balance of pressures in the external measurement point can be expressed as follows:
PATM+PE+PAWE=PAOE, (8)
where PE- additional external pressure applied to the tissue surrounding the eyeball, so that the outer diameter DEartery HA decreases until, unless there is a teacher who>/p>It is possible to formulate the equation of balance of pressures between the inner and outer measurement points using equation (5):
PATM+PE+PAWE=PATM+PIC+PAWI-P. (9)
In this way, measure only the magnitude of REVEand VI. If the value of the external pressure PEchose to comply with the equality VE=VIthis means that DE=DI. This is the result of a balance of pressures. Then PAWI=PAWEand the final equation of balance of pressures can be expressed as follows:
PIC=PE+P;; if VE=VI. (10)
From equation (10) implies that the intracranial pressure PICis approximately equal to PEif we can neglectPand PIC=PEifPso little, as calculated using equation (6), and either compensate for or attributed to measurement errors.

Using the device of the invention, the author has the ability to measure the pressure inside the human head without the need neposredno resistance of ophthalmic branches of the HA or other individual parameters of patients or processes of self-regulation. Only the value ofPdepends on RMCAVIand other individual parameters. However, in most practical cases, the value ofPcan be neglected, because in clinical practice is not required to measure the PICwith an absolute error of less than3 mm RT.article.

In Fig. 1 and 2 shows a device 20 for measuring intracranial pressure by the method described above. The device can be fixed on the man's head so that the eyes, touching the inflatable device 22, is slightly pressed by the age of 23. Suitable brackets and straps 24, 26 are used to hold the device 22 in place. The device 22 is made of a suitable soft material, such as rubber, in the form of an inflatable chamber 28. The camera 28 to form an approximately annular, it allows you to set the ultrasonic transducer 30 on the inner flexible membrane 32, and also gives the ability to create pressure in the pump chamber 34.

The inner membrane conforms to the shape of the eye 35, as shown in the drawing, and thus allows the pressure in the pumping chamber 28 to exert a slight pressure on Danute skull 40 and passes through the channel 42 of the optic nerve to the eye 35.

The ultrasonic transducer 30 has a Central axis 44, which can be aligned by adjusting the position of the transducer within its fastening to the device 22. This alignment allows you to adjust the angle of the axis 44 so as to direct ultrasonic acoustic pulses both internal and external sections 46, 48 of the ophthalmic artery 36 under the same angle. This alignment of the Doppler measurement of blood flow in these different sections 46, 48 can be produced without formation of the errors associated with different angles of the axis 44 relative to the sections 46 and 48. Therefore, it is possible to obtain a reliable measurement of intracranial pressure PIC.

The ultrasonic transducer 30 has an input bus 50 connected to the acoustic pulse transmitter 52. The Converter 30 also acts as a receiver of sound vibrations, so that its input bus transmitter 52 is connected to the valve 54. The input of gate 56 is enabled by the transmitter 52 to protect the receiver 58 of strong output pulses of the transmitter during activation of the transducer 30. The receiver 58 generates on bus 60 output signal representing the acoustic echo from blood flow in the ophthalmic artery HA caused ultrazvukovye opportunity discriminates those parts of the echo signal, that display the flow velocity or the inside of the skull, or outside in the ophthalmic artery. Circuit 62 produces on line 64 signal select "internal", and on line 66 signal select "external". Signal select "internal" served on the valve 67 logical And that discriminates for further processing echo signals related to blood flow within the skull. Similarly, the signal "external" served on the valve 68 logical And that discriminates for further processing echo signals related to blood flow in the ophthalmic artery outside of the skull. Circuit 62 operates on the principle of selection of the range from which you can choose acoustic responses from different depths for analysis of Doppler frequency shift relative to the transmitter frequency fWith.

The selection signals "internal" and "external" produce consistently well-known manner, through activation of the controller 70 after each pulse of the transmitter signal on line 56. The outputs of gates 67, 58 are connected through the element OR 72 to the frequency counter 74. He samples the received echo signal and generates the select signals, such as signal frequency fIin the pulse adjusting the speed of blood flow within the skull; the signal h>in the transmitted pulse. Selective frequency signals remain in a suitable memory 76, and in block 78 determines the frequency shifts from the frequency of the transmitted pulse, such asC-fIfC-fE. To fill these functions, you can apply a suitable microprocessor.

For each pulse of the transmitter and the resultant echo signal, it is possible to determine the frequency shift. Each frequency shift corresponds to the velocity of blood in the ophthalmic artery, and you can store values in such a way as to provide the internal reference speed of blood VIand external speed blood VEin block 78. These signals of blood flow velocity can be displayed as curves 79.1 and 79.2, as shown in Fig.5, or to combine (see 79.3 in Fig.3) to more clearly display their relative values or the difference betweenV determined in block 80. Note that the activation speed sensor 52 set considerably high in order to be able to determine the shape of the velocity curves 79, Then display the value of the velocity differenceV, and these readings are used to determine intracranial pressure.

The differenceV used to determine unna, when the differenceV fall below the minimum levelVmin. This value is taken for the resolution of the measurement VIand VE. Measurement of PICcan produce by manually increasing the pressure inside the device 22 until such time as the visual indication of the measurement signals of the flow velocity VIand VEor shifts the frequency will be equal; or by using automatic control systems, such as block 82.

Alternatively, the regulator can implement, for example, first checking in block 84 whether the value ofV less than the minimum levelVmin. If the test result is negative, then in block 86 increase the value of the pump pressure, and this value is fed to the pump 34 to cause increased pressure within the inflatable device 22. The pressure transducer 90 is sensitive to the pressure inside the chamber 28 and generates a signal pressure Pmcorresponding to the pressure.

When the result of the check in block 84 becomes positive, a value of Pmkeep in block 92 as evidence of internal cranial pressure is TBA 20 preferably to produce an initial alignment mode to ensure that the pulses of the transmitter with the Converter 30 is properly aimed at the internal and external sections 46 and 48 of the ophthalmic artery 36. This operation involves configuring an anglebetween the axis 44 of the ultrasonic transducer 30 and the axis 96 of the channel 42 of the ophthalmic artery. The adjustment can be performed by using the adjustment screws 98.1 and 98.2 or using other suitable frame, pinned between the belt 26 and transducer 30 of Fig.1.

In Fig.4 depicts a procedure 100 of this configuration. Thus, at operation 102, the device 20 initialize, and at operation 104 establish operational contact between the acoustic transmitter 30 and age, watching the echo signals on the display. At operation 106 sets the depth of real-time measurements, RE, see Fig. 1, using the control unit operational depth measurement 70 (see Fig. 1). Typical initial values of REthere are approximately between 40 and 50 mm

At operation 108 change the angle in spacethe axis 44 of the transducer, so as to find the speed signal associated with the outer section 48 of the ophthalmic artery. It detect by observation form p://img.russianpatents.com/chr/966.gif">1in which reach the maximum level of the Doppler signal, select operations 110 and celebrate.

At operation 112 in the control unit 70 enter the initial value of the internal depth measurements RI. Typical values of RIare in the range of from about 52 to 65 mm

At operation 114 define a spatial angle2alignment of the transducer 30, which reach maximum pulsation Doppler signal from the inner section 46 of the ophthalmic artery 36. Operative direction of the transducer 30 is chosen at operation 116 by aligning the axis 44 of the transducer 30 along the median between the angles1and2.
Then, in operation 118, the depth regulator measuring 70 activates so that the flow velocity within the inner and outer sections 46, 48 of the ophthalmic artery were measured sequentially. The depth of the external and internal input channel of the optic nerve is determined by increasingEfrom the values in the range between the first value selected at operation 106, and a second value selected in operation 112, while observing the velocity fluctuations, as shown in Fig. 5. And Aleut depth R1and R2channel inputs, respectively, of the outer and inner area of the optic nerve. This is done by monitoring the decrease of the amplitudes of the pulses of blood flow velocity, as shown in Fig.5, such a decrease is typical of measurements made inside the channel of the optic nerve, compared with the amplitudes of the pulses of the speed of blood flow out of the channel of the optic nerve.

Thereafter, at operation 122 set the final values of REand RIusing the criterion RE<Rand RI>R2. Once identified and fixed the position of the ultrasonic transducer, it is possible to measure the external and internal velocities of blood, as described above. Reading intracranial pressure PICget when the results of the speed measurements are the same.

In Fig. 3 depicts a simplified system 140 to determine the internal cranial pressure. In the system used inflatable device 22, as shown and described in Fig.1, attached hand pump 142, similar to that used in conjunction with stethoscopes. The pump 142 is connected to a flexible tube 144 through the valve 146 and to the inflatable device 22. With the tube 144 is connected a pressure gauge 148 to display pressure in visua the Ghana management and Doppler meter 150 is equipped with a display 152.

When the values of internal and external velocities are equal that they see on the display 152, there is the option to manually apply a signal to the pressure gauge 148, so he kept the pressure indicator as a measurement of intracranial pressure PIC.

After this description of illustrative devices and methods for determining intracranial pressure in accordance with the invention, persons who are familiar with this technical field, can develop variations. The embodiments of the invention described herein, other equivalent circuits that can develop persons who are familiar with this technical field, should be considered part of this invention. For example, a special version of the circuit shown in Fig. 1, can be done using other types of devices and logic circuits, and can be implemented in analog form, as all these options are well known to persons familiar with this technical field. Therefore, the invention should be interpreted in accordance with the procedure outlined in this document and in this paragraph, and in accordance with the invention.


Claims

1. The device is placed on the eye to change the speed of blood flow and the ultrasound transducer with an acoustic pulse transmitter and receiver, characterized in that the inflatable chamber, the acoustic pulse transmitter is connected through the valve connected to the receiver, configured to output bus output signal to the control circuit depth is made with the possibility of the formation of successively through the depth regulator metering signals select “internal” and “external” through the respective outputs of logical And gates and the OR element connected to the frequency counter samples associated with the memory connected to the block for determining a frequency shift from the frequency of the transmitted pulse, and to increase the pressure in the inflatable chamber unit increase pressure pump connected to the pump, when the pressure transducer is a pressure sensor chamber and is configured to generate a signal intracranial pressure.

2. The device according to p. 1, wherein the block of determining the differenceV to determine the intracranial pressure is arranged to display its internal reference VIand external VEvelocity and blood corresponding frequency shift in the definition block of the frequency shift.

3. The device under item 1, characterized in that will complement the automatic regulator containing block comparing the differenceV andVminassociated with a unit increase of the pressure pump and the block memory readings intracranial pressure.

4. A device for determining blood flow velocity in the ophthalmic artery containing an ultrasonic transducer with an acoustic pulse transmitter and receiver, camera, made with the possibility of application of pressure on the eye to change the speed of the flow, characterized in that the chamber is inflatable, with application of pressure in the ophthalmic artery and installation of the ultrasonic transducer, which is made with the possibility of adjusting the position of the Central axis direction of the ultrasonic pulses in the internal and external areas of the ophthalmic artery, the acoustic pulse transmitter through the valve connected to the receiver, configured to output bus output signal to the control circuit depth, made with the possibility of the formation of successively through the depth regulator metering signals select “internal” and “external” through the respective outputs of logical And gates and the OR element connected to the counter cassopolis, corresponding to the velocity of blood in the ophthalmic artery.

5. The device according to p. 4, characterized in that the ultrasonic transducer is made with the possibility of adjusting the position of the Central axis direction of the ultrasonic pulses both internal and external area of the ophthalmic artery, determining the spatial angle1that is the maximum level of the Doppler signal at the internal site and the spatial angle2, wherein the maximum pulsation Doppler signal on the external area of the ophthalmic artery and selecting the operational direction of the axis of the transducer along the median between the angles1and2, and control the depth measurement is made with the possibility of consecutive measurements of blood flow velocity within the inner and outer sections of the ophthalmic artery.

6. The device under item 5, wherein the inflatable chamber flexible tube, through the valve, attached hand pump, and the tube is connected with a pressure indicator to display it in a visual and/or digital form.

7. The device according to p. 6, characterized in that Citgo pressure in eyes with ocular artery in which measure blood flow, the generation of the acoustic pulse signals for its measurement, wherein changing the angle of the Central axis of the transducer, determine the velocity of the blood flow on the external area of the ophthalmic artery on the maximum level of the Doppler signal on the domestic leg - maximum pulsation Doppler signal and receive their difference, then change the external pressure on the eye to the level at which the differential value falls below the minimum level and receive an indication of intracranial pressure.

9. The method according to p. 8, wherein the indication of intracranial pressure reflect on display.

 

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6 cl

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