A Patient-Specific Electrical Twin of Intracranial Pressure Dynamics Validated by Clinical Infusion Tests

Abstract

Understanding intracranial pressure (ICP) dynamics is essential for interpreting clinical infusion tests used in the diagnosis of cerebrospinal fluid circulation disorders. However, the complex coupling between vascular pulsations, cerebrospinal fluid flow, and intracranial compliance makes quantitative interpretation of these tests challenging. Here, I present a patient specific simulation framework based on an extended electrical analog model that reproduces intracranial pressure dynamics observed during clinical infusion tests. The model integrates physiological inputs including arterial blood pressure, heart rate, respiratory rhythm, and resistance to cerebrospinal fluid outflow derived from clinical data. Built upon the classical Ursino framework, the model incorporates several modifications enabling realistic representation of physiological pulsations and infusion test conditions. The resulting system functions as a hybrid electrical-numerical simulation model representing a simplified digital electrical twin of intracranial hydrodynamics. The model was validated using data from 21 clinical infusion tests performed in patients with suspected normal pressure hydrocephalus. Simulated intracranial pressure recordings were compared with clinical measurements using regression and residual analysis. The simulations demonstrated strong agreement with measured data, with a mean correlation coefficient of r = 0.95 (95% CI 0.94 - 0.96), mean residual values within -1.71 to +1.68 mmHg, and a mean root mean square error (RMSE) of 2.07 mmHg. These results demonstrate that the proposed model accurately reproduces the dynamic behavior of intracranial pressure observed during clinical infusion tests. The framework provides a physiologically grounded computational tool for studying patient specific intracranial dynamics and may support improved interpretation of infusion test results in clinical practice.