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 Cerebral Blood Flow

Regulation of cerebral blood flow

  • Mechanical effects on cerebral blood flow.
  • Neurogenic coupling mechanisms in cerebral blood flow.
  • Local effects on cerebral blood flow.

Methods for evaluating cerebral blood flow

  • Experimental methods (pial artery diameter, hydrogen diffusion, radioactive microspheres, laser Doppler).
  • Clinical methods (Duplex ultrasound, transcranial ultrasound, xenon clearance, single photon emission cerebral tomography, magnetic resonance angiography, magnetic resonance spectroscopy, perfusion/diffusion MRI, positron emission tomography).

Clinical research areas in cerebral blood flow

  • Pharmacologic effects on cerebral blood flow.
  • Effects of anesthesia on autoregulation.
  • Neonatal cerebral blood flow.
  • Cerebral blood flow in altitude sickness.
  • Cerebral blood flow following cardiac arrest.
  • Head trauma and cerebral blood flow.
  • Hemodynamics of atherosclerotic cerebrovascular disease.

References

Wahl M, Schilling L. Regulation of cerebral blood flow--a brief review. Acta Neurochir Suppl (Wien) 1993;59:3-10.

Cerebral blood flow is largely independent of perfusion pressure when autoregulation is intact. The mechanisms of cerebral autoregulation are reviewed in this paper, including the role of local-chemical factors, endothelial factors, autacoids, and transmitters from perivascular nerves.

Griffiths PD, Hoggard N, Dannels WR, Wilkinson ID. In vivo measurement of cerebral blood flow: a review of methods and applications. Vasc Med 2001;6:51-60.

This article reviews the concepts of cerebral blood flow for the clinician involved in the management of patients with carotid stenosis and/or ischaemic stroke. Methods of assessing cerebral blood flow in vivo using nuclear medicine, magnetic resonance and X-ray computed tomography are described. Applications of magnetic resonance and X-ray computed tomographic methods are reviewed and illustrated by examples from the authors' radiological practice.

Young WL, Prohovnik I, Correll JW, Ostapkovich N, Ornstein E, Quest DO. A comparison of cerebral blood flow reactivity to CO2 during halothane versus isoflurane anesthesia for carotid endarterectomy. Anesth Analg 1991;73:416-421.

The effects of isoflurane or halothane on cerebral blood flow (CBF) reactivity to changes in arterial carbon dioxide tension during carotid endarterectomy were compared using the intravenous method of 133Xe-CBF determination. It is concluded that there is no significant difference between halothane and isoflurane in their effects on CO2 reactivity in the mildly hypocapnic to normocapnic range.

Golding EM. Sequelae following traumatic brain injury. The cerebrovascular perspective. Brain Res Brain Res Rev 2002;38:377-388.

Although vascular damage is a key event, it remains a somewhat neglected component to the underlying degenerative processes that evolve following injury to the brain. The present review integrates the current knowledge of the vascular events proceeding injury to the brain, with an emphasis on how this impacts the control of vascular function and thus cerebral blood flow.

Derdeyn CP, Grubb RL Jr, Powers WJ. Cerebral hemodynamic impairment: methods of measurement and association with stroke risk. Neurology 1999;53:251-259.

This article reviews the responses of the cerebral vasculature to reduced perfusion pressure, examines their association with strike risk, presents various methods of hemodynamic assessment and discusses their clinical applications.

Posted June 2010