Noninvasive Brain Physiology Monitoring for Extreme Environments: A Critical Review

Our ability to monitor the brain physiology is advancing; however, most of the technology is bulky, expensive, and designed for traditional clinical settings. With long-duration space exploration, there is a need for developing medical technologies that are reliable, low energy, portable, and semiautonomous. Our aim was to review the state of the art for noninvasive technologies capable of monitoring brain physiology in diverse settings. A literature review of PubMed and the Texas Medical Center library sites was performed using prespecified search criteria to identify portable technologies for monitoring physiological aspects of the brain physiology. Most brain-monitoring technologies require a moderate to high degree of operator skill. Some are low energy, but many require a constant external power supply. Most of the technologies lack the accuracy seen in gold standard measures, due to the need for calibration, but may be useful for screening or monitoring relative changes in a parameter. Most of the technologies use ultrasound or electromagnetic radiation as energy sources. There is an important need for further development of portable technologies that can be operated in a variety of extreme environments to monitor brain health.

[1]  Fady T. Charbel,et al.  Frequency domain near-infrared spectroscopy technique in the assessment of brain oxygenation: A validation study in live subjects and cadavers , 2006, Journal of Neuroscience Methods.

[2]  C. Polman,et al.  The physiological variation of the retinal nerve fiber layer thickness and macular volume in humans as assessed by spectral domain-optical coherence tomography. , 2012, Investigative ophthalmology & visual science.

[3]  T. Steiner,et al.  Prediction of intracranial pressure from noninvasive transocular venous and arterial hemodynamic measurements , 2004, Neurocritical care.

[4]  G. Strangman,et al.  Depth Sensitivity and Source-Detector Separations for Near Infrared Spectroscopy Based on the Colin27 Brain Template , 2013, PloS one.

[5]  D. Boas,et al.  Haemoglobin oxygen saturation as a biomarker: the problem and a solution , 2011, Philosophical Transactions of the Royal Society A: Mathematical, Physical and Engineering Sciences.

[6]  Arminas Ragauskas,et al.  Investigation of intracranial media ultrasonic monitoring model. , 2002, Ultrasonics.

[7]  Steven W. Mundell,et al.  Ophthalmodynamometry for ICP prediction and pilot test on Mt. Everest , 2010, BMC neurology.

[8]  E. Ryding,et al.  Transcranial Doppler sonography pulsatility index (PI) reflects intracranial pressure (ICP). , 2004, Surgical neurology.

[9]  F. Kirkham,et al.  The tympanic membrane displacement analyser for monitoring intracranial pressure in children , 2013, Child's Nervous System.

[10]  Arminas Ragauskas,et al.  Non-invasive Absolute Intracranial Pressure Measurement without Problem of Calibration: Healthy Volunteer Study , 2009 .

[11]  L. Desch,et al.  Longitudinal stability of visual evoked potentials in children and adolescents with hydrocephalus , 2001, Developmental medicine and child neurology.

[12]  Simon J Mitchell,et al.  Decompression illness , 2011, The Lancet.

[13]  Rafael Puyol,et al.  A portable, high density EEG acquisition system , 2013, 2013 7th Argentine School of Micro-Nanoelectronics, Technology and Applications.

[14]  H. Mattle,et al.  Contrast-enhanced transcranial Doppler ultrasound for diagnosis of patent foramen ovale. , 2006, Frontiers of neurology and neuroscience.

[15]  J. Zhou,et al.  Clinical experience with the noninvasive ICP monitoring system. , 2005, Acta neurochirurgica. Supplement.

[16]  Fernando Seoane,et al.  Electrical Bioimpedance cerebral monitoring. Preliminary results from measurements on stroke patients , 2012, 2012 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[17]  R. Firsching,et al.  Noninvasive assessment of intracranial pressure with venous ophthalmodynamometry. Clinical article. , 2011, Journal of neurosurgery.

[18]  R. Chesnut,et al.  The localizing value of asymmetry in pupillary size in severe head injury: relation to lesion type and location. , 1994, Neurosurgery.

[19]  S. E. Voss,et al.  Posture-induced changes in distortion-product otoacoustic emissions and the potential for noninvasive monitoring of changes in intracranial pressure , 2006, Neurocritical care.

[20]  David A Boas,et al.  Diffuse optical imaging of the whole head. , 2006, Journal of biomedical optics.

[21]  D. Weese-Mayer,et al.  Pupillometry in congenital central hypoventilation syndrome (CCHS): quantitative evidence of autonomic nervous system dysregulation , 2012, Pediatric Research.

[22]  M. Dujovny,et al.  Advances in ICP monitoring techniques , 2003, Neurological research.

[23]  K. Fountas,et al.  Clinical implications of quantitative infrared pupillometry in neurosurgical patients , 2006, Neurocritical care.

[24]  Michael R. Barratt,et al.  Ophthalmic changes and increased intracranial pressure associated with long duration spaceflight: An emerging understanding , 2013 .

[25]  Kelvin O. Lim,et al.  Evidence of disrupted functional connectivity in the brain after combat-related blast injury , 2011, NeuroImage.

[26]  S. E. Voss,et al.  Posture systematically alters ear-canal reflectance and DPOAE properties , 2010, Hearing Research.

[27]  Richard H. Bayford,et al.  Three-Dimensional Electrical Impedance Tomography of Human Brain Activity , 2001, NeuroImage.

[28]  William D Freeman,et al.  Validation of frontal near-infrared spectroscopy as noninvasive bedside monitoring for regional cerebral blood flow in brain-injured patients. , 2012, Neurosurgical focus.

[29]  Ö. Ünal,et al.  Acute mountain sickness occurring with corpus callosum, globus pallidus and cerebellar peduncle involvement: MRI findings , 2010 .

[30]  C. Owen,et al.  Optic nerve sheath diameter, intracranial pressure and acute mountain sickness on Mount Everest: a longitudinal cohort study , 2006, British Journal of Sports Medicine.

[31]  C. Linstrom,et al.  How to Measure Cerebrospinal Fluid Pressure Invasively and Noninvasively , 2013, Journal of glaucoma.

[32]  David A. Boas,et al.  Factors affecting the accuracy of near-infrared spectroscopy concentration calculations for focal changes in oxygenation parameters , 2003, NeuroImage.

[33]  P. Hackett,et al.  Optic nerve sheath diameter and acute mountain sickness. , 2013, Wilderness & environmental medicine.

[34]  David S. Holder,et al.  Impedance changes recorded with scalp electrodes during visual evoked responses: Implications for Electrical Impedance Tomography of fast neural activity , 2009, NeuroImage.

[35]  Gui-Shuang Ying,et al.  In vivo detection of experimental optic neuritis by pupillometry. , 2012, Experimental eye research.

[36]  T. Gerds,et al.  Diagnostic value of optical coherence tomography for intracranial pressure in idiopathic intracranial hypertension , 2013, The Journal of Headache and Pain.

[37]  Barbara Pizzi,et al.  Reliability of Optic Nerve Ultrasound for the Evaluation of Patients with Spontaneous Intracranial Hemorrhage , 2009, Neurocritical care.

[38]  Marco Ferrari,et al.  A brief review on the history of human functional near-infrared spectroscopy (fNIRS) development and fields of application , 2012, NeuroImage.

[39]  E. Jonkman,et al.  The average visual response in patients with cerebrovascular disease. , 1969, Electroencephalography and clinical neurophysiology.

[40]  P. Avan,et al.  Middle-ear influence on otoacoustic emissions. II: Contributions of posture and intracranial pressure , 2000, Hearing Research.

[41]  V. Noble,et al.  Optic nerve sheath diameter correlates with the presence and severity of acute mountain sickness: evidence for increased intracranial pressure. , 2009, Journal of applied physiology.

[42]  Arminas Ragauskas,et al.  Ophthalmic Artery as a sensor for non-invasive intracranial pressure measurement electronic system , 2012 .

[43]  M. Edsell,et al.  Changes in pupil dynamics at high altitude--an observational study using a handheld pupillometer. , 2008, High altitude medicine & biology.

[44]  L. Sakata,et al.  Optical coherence tomography of the retina and optic nerve – a review , 2009, Clinical & experimental ophthalmology.

[45]  David A. Boas,et al.  Validating atlas-guided DOT: A comparison of diffuse optical tomography informed by atlas and subject-specific anatomies , 2012, NeuroImage.

[46]  M. Twa,et al.  Quantitative evaluation of factors influencing the repeatability of SD-OCT thickness measurements in the rat. , 2012, Investigative ophthalmology & visual science.

[47]  Simon R. Arridge,et al.  Three-dimensional whole-head optical tomography of passive motor evoked responses in the neonate , 2006, NeuroImage.

[48]  Y. Murawaki,et al.  Cerebral pulsatility index by transcranial Doppler sonography predicts the prognosis of patients with fulminant hepatic failure. , 2010, Clinical imaging.

[49]  T. Durduran,et al.  Effects of acetazolamide on the micro- and macro-vascular cerebral hemodynamics: a diffuse optical and transcranial doppler ultrasound study , 2010, Biomedical optics express.

[50]  H. Hovagimian,et al.  Development of a remote pupillometer system for non-invasive, distant analysis , 2012, 2012 38th Annual Northeast Bioengineering Conference (NEBEC).

[51]  B. Petrig,et al.  Intraocular pressure during a very high altitude climb. , 2010, Investigative ophthalmology & visual science.

[52]  M. Arango,et al.  Near-infrared spectroscopy as an index of brain and tissue oxygenation. , 2009, British journal of anaesthesia.

[53]  N. Yanagita,et al.  Eustachian Tube Function and Middle Ear Barotrauma Associated with Extremes in Atmospheric Pressure , 1996, The Annals of otology, rhinology, and laryngology.

[54]  P. Avan,et al.  Effects of glycerol intake and body tilt on otoacoustic emissions reflect labyrinthine pressure changes in Menière’s disease , 2009, Hearing Research.

[55]  A. Alexandrov,et al.  Advances in transcranial doppler ultrasonography , 2009, Current neurology and neuroscience reports.

[56]  W. He,et al.  The role of noninvasive monitoring of cerebral electrical impedance in stroke. , 2005, Acta neurochirurgica. Supplement.

[57]  Alok Sharma,et al.  Clinical evaluation of a portable near-infrared device for detection of traumatic intracranial hematomas. , 2010, Journal of neurotrauma.

[58]  B. Godley,et al.  Ocular outcomes evaluation in a 14-day head-down bed rest study. , 2014, Aviation, space, and environmental medicine.

[59]  Alexander Hartov,et al.  Intracranial Electrical Impedance Tomography: A Method of Continuous Monitoring in an Animal Model of Head Trauma , 2013, Anesthesia and analgesia.

[60]  Turgut Durduran,et al.  Transcranial diffuse optical monitoring of microvascular cerebral hemodynamics after thrombolysis in ischemic stroke , 2014, Journal of biomedical optics.

[61]  P. Bärtsch,et al.  [High altitude medicine]. , 2001, Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS.

[62]  J. Detre,et al.  Noninvasive Measurement of Cerebral Blood Flow and Blood Oxygenation Using Near-Infrared and Diffuse Correlation Spectroscopies in Critically Brain-Injured Adults , 2010, Neurocritical care.

[63]  H. Dehghani,et al.  Diffuse optical imaging , 2009, Philosophical Transactions of the Royal Society A: Mathematical, Physical and Engineering Sciences.

[64]  A. Mendelow,et al.  Clinical comparison of tympanic membrane displacement with invasive intracranial pressure measurements , 2005, Physiological measurement.

[65]  J. Włodyka Studies on Cochlear Aqueduct Patency , 1978, The Annals of otology, rhinology, and laryngology.

[66]  J. Macdonald,et al.  Optic nerve sheath diameter is not related to high altitude headache: a randomized controlled trial. , 2012, High altitude medicine & biology.

[67]  Jennifer Law,et al.  Flat spin and negative Gz in high-altitude free fall: pathophysiology, prevention, and treatment. , 2013, Aviation, space, and environmental medicine.

[68]  D. Liu,et al.  Measurement and relationship of subarachnoid pressure of the optic nerve to intracranial pressures in fresh cadavers. , 1993, American journal of ophthalmology.

[69]  C. Elwell,et al.  A portable wireless near-infrared spatially resolved spectroscopy system for use on brain and muscle. , 2013, Medical engineering & physics.

[70]  G. Hwang,et al.  Noninvasive estimation of raised intracranial pressure using ocular ultrasonography in liver transplant recipients with acute liver failure -A report of two cases- , 2013, Korean journal of anesthesiology.

[71]  Jeffrey J. Fletcher,et al.  Optic Nerve Ultrasound for the Detection of Raised Intracranial Pressure , 2011, Neurocritical care.

[72]  A. Gouliamos,et al.  Optic nerve sonography: a new window for the non-invasive evaluation of intracranial pressure in brain injury , 2009, Emergency Medicine Journal.

[73]  H. Hartung,et al.  Intracranial venous pressure is normal in patients with multiple sclerosis , 2011, Multiple sclerosis.

[74]  D. Arciniegas,et al.  Mild traumatic brain injury: a neuropsychiatric approach to diagnosis, evaluation, and treatment , 2005, Neuropsychiatric disease and treatment.

[75]  D. York,et al.  Relationship between visual evoked potentials and intracranial pressure. , 1981, Journal of neurosurgery.

[76]  Thomas A Gennarelli,et al.  Quantitative pupillometry, a new technology: normative data and preliminary observations in patients with acute head injury. Technical note. , 2003, Journal of neurosurgery.

[77]  J. Milledge Altitude medicine and physiology including heat and cold: a review. , 2006, Travel medicine and infectious disease.

[78]  Turgut Durduran,et al.  Validation of diffuse correlation spectroscopic measurement of cerebral blood flow using phase-encoded velocity mapping magnetic resonance imaging. , 2012, Journal of biomedical optics.

[79]  Robert W. Thatcher,et al.  Validity and Reliability of Quantitative Electroencephalography , 2010 .

[80]  M. Fink,et al.  Functional ultrasound imaging of the brain: theory and basic principles , 2013, IEEE Transactions on Ultrasonics, Ferroelectrics and Frequency Control.

[81]  Arjun G. Yodh,et al.  Diffuse correlation spectroscopy for non-invasive, micro-vascular cerebral blood flow measurement , 2014, NeuroImage.

[82]  V. Sharma,et al.  Noninvasive estimation of intracranial pressure using TCD , 2015 .

[83]  John S Werner,et al.  Baseline OCT measurements in the idiopathic intracranial hypertension treatment trial, part II: correlations and relationship to clinical features. , 2014, Investigative ophthalmology & visual science.

[84]  R. Firsching,et al.  Ophthalmodynamometry: a reliable method for measuring intracranial pressure , 2001, Strabismus.

[85]  Alex J. Baneke,et al.  What role does the blood brain barrier play in acute mountain sickness? , 2010, Travel medicine and infectious disease.

[86]  Larry A Kramer,et al.  Optic disc edema, globe flattening, choroidal folds, and hyperopic shifts observed in astronauts after long-duration space flight. , 2011, Ophthalmology.

[87]  L. J. Hartman Ophthalmodynamometric estimation of cerebrospinal fluid pressure in pseudotumour cerebri , 2003 .

[88]  J. Bartek,et al.  Intracranial Pressure Monitoring: Invasive versus Non-Invasive Methods—A Review , 2012, Critical care research and practice.

[89]  Mary Shultz,et al.  Comparing test searches in PubMed and Google Scholar. , 2007, Journal of the Medical Library Association : JMLA.

[90]  Sean L. Jersey,et al.  Severe neurological decompression sickness in a U-2 pilot. , 2010, Aviation, space, and environmental medicine.

[91]  J. Detre,et al.  Continuous Optical Monitoring of Cerebral Hemodynamics During Head-of-Bed Manipulation in Brain-Injured Adults , 2014, Neurocritical Care.

[92]  Arminas Ragauskas,et al.  Clinical Assessment of the Accuracy of ICP Non-invasive Measurement , 2010 .

[93]  Jian Wang,et al.  Measurement of Brain Edema by Noninvasive Cerebral Electrical Impedance in Patients with Massive Hemispheric Cerebral Infarction , 2012, European Neurology.

[94]  Henrique Barros,et al.  Assessment of autonomic function in high level athletes by pupillometry , 2003, Autonomic Neuroscience.

[95]  K. Manwaring,et al.  A signal analysis algorithm for determining brain compliance non-invasively , 2004, The 26th Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[96]  W. Eric L. Grimson,et al.  Anatomical atlas-guided diffuse optical tomography of brain activation , 2009, NeuroImage.

[97]  A. Sargsyan,et al.  Sonography for Determining the Optic Nerve Sheath Diameter With Increasing Intracranial Pressure in a Porcine Model , 2011, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[98]  W. Lagrèze,et al.  Dependence of the optic nerve sheath diameter on acutely applied subarachnoidal pressure – an experimental ultrasound study , 2011, Acta ophthalmologica.