Noninvasive Indicators of Intracranial Pressure Before, During, and After Long-Duration Spaceflight

Weightlessness induces a cephalad shift of blood and cerebrospinal fluid that may increase intracranial pressure (ICP) during spaceflight, while lower body negative pressure (LBNP) may provide an opportunity to caudally redistribute fluids and lower ICP. To investigate the effects of spaceflight and LBNP on noninvasive indicators of ICP (nICP), we studied thirteen crewmembers before and after spaceflight in seated, supine, and 15° head-down tilt postures, and at ~45 and ~150 days of spaceflight with and without 25 mmHg LBNP. We used 4 techniques to quantify nICP: cerebral and cochlear fluid pressure (CCFP), otoacoustic emissions (OAE), ultrasound measures of optic nerve sheath diameter (ONSD), and ultrasound-based internal jugular vein pressure (IJVp). On flight day 45, two nICP measures were lower than preflight supine posture (CCFP: mean difference -98.5 -nl [CI: -190.8 to -6.1 -nl], p = 0.037]; OAE: -19.7 degrees [CI: -10.4 to -29.1 degrees], p < 0.001), but not significantly different from preflight seated measures. Conversely, ONSD was not different than any preflight posture, whereas IJVp was significantly greater than preflight seated measures (14.3 mmHg [CI: 10.1 to 18.5mmHg], p < 0.001), but not significantly different than preflight supine measures. During spaceflight, acute LBNP application did not cause a significant change in nICP indicators. These data suggest that during spaceflight nICP is not elevated above values observed in the seated posture on Earth. Invasive measures would be needed to provide absolute ICP values and more precise indications of ICP change during various phases of spaceflight.