Effects of increased ICP on brain phosphocreatine and lactate determined by simultaneous 1H and 31P NMR spectroscopy.

In order to study the metabolic events surrounding ischemia induced by the graded increase of cerebrospinal fluid (CSF) pressure, the technique of simultaneous phosphorus-31- and hydrogen-1-enhanced nuclear magnetic resonance spectroscopy was applied to five cats as intracranial pressure (ICP) was gradually raised by the instillation of mock CSF. Threshold lactate rose at an average cerebral perfusion pressure (CPP) of 49 torr, and, in general, preceded a threshold decrease in phosphocreatine, which was observed at an average CPP of 29 torr. There was considerable variation among cats in the CPP at which failure of brain energy metabolism occurred, however, suggesting differences in the autoregulatory curves. It is concluded that, with elevated ICP, there is no universally "safe" CPP at which brain energy metabolism may be assumed to be uncompromised.