PDF herunterladen
J Neurol Surg A Cent Eur Neurosurg 2021; 82(03): 257-261
DOI: 10.1055/s-0040-1721682
Review Article

A Brief Review of Brain's Blood Flow–Metabolism Coupling and Pressure Autoregulation

Themistoklis Papasilekas
1   Department of Neurosurgery, Evangelismos Athens General Hospital, Athens, Attica, Greece
,
Konstantinos Michail Themistoklis
1   Department of Neurosurgery, Evangelismos Athens General Hospital, Athens, Attica, Greece
,
Konstantinos Melanis
2   Department of Neurology, Evangelismos Athens General Hospital, Athens, Attica, Greece
,
Panayiotis Patrikelis
1   Department of Neurosurgery, Evangelismos Athens General Hospital, Athens, Attica, Greece
,
Eleftherios Spartalis
3   Laboratory of Experimental Surgery and Surgical Research, University of Athens, Athinon, Greece
,
Stefanos Korfias
1   Department of Neurosurgery, Evangelismos Athens General Hospital, Athens, Attica, Greece
,
Damianos Sakas
1   Department of Neurosurgery, Evangelismos Athens General Hospital, Athens, Attica, Greece
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Background The human brain, depending on aerobic glycolysis to cover its metabolic needs and having no energy reserves whatsoever, relies on a constant and closely regulated blood supply to maintain its structural and functional integrity. Cerebral autoregulation, that is, the brain's intrinsic ability to regulate its own blood flow independently from the systemic blood pressure and cardiac output, is an important physiological mechanism that offers protection from hypoperfusion injury.

Discussion Two major independent mechanisms are known to be involved in cerebral autoregulation: (1) flow–metabolism coupling and (2) myogenic responses of cerebral blood vessels to changes in transmural/arterial pressure. A third, less prominent component of cerebral autoregulation comes in the form of neurogenic influences on cerebral vasculature.

Conclusion Although fragmentation of cerebral autoregulation in separate and distinct from each other mechanisms is somewhat arbitrary, such a scheme is useful for reasons of simplification and to better understand their overall effect. Comprehension of cerebral autoregulation is imperative for clinicians in order for them to mitigate consequences of its impairment in the context of traumatic brain injury, subarachnoid hemorrhage, stroke, or other pathological conditions.

Keywords

cerebral autoregulation - cerebral blood flow - flow–metabolism coupling


Publikationsverlauf

Eingereicht: 24. September 2019

Angenommen: 12. März 2020

Artikel online veröffentlicht:
14. Februar 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Sakas DE. Introduction to Neurosurgery. Athens: Parisianos; 2003
    Suche in Google Scholar
  • 2 Byrne JV. Control of cerebral blood flow. In: Tutorials in Endovascular Neurosurgery and Interventional Neuroradiology. Berlin: Springer; 2012: 83-96
    CrossrefSuche in Google Scholar
  • 3 Hall CN, Reynell C, Gesslein B. et al. Capillary pericytes regulate cerebral blood flow in health and disease. Nature 2014; 508 (7494): 55-60
    CrossrefPubMedSuche in Google Scholar
  • 4 Ursino M, Lodi CA. A simple mathematical model of the interaction between intracranial pressure and cerebral hemodynamics. J Appl Physiol (1985) 1997; 82 (04) 1256-1269
    CrossrefPubMedSuche in Google Scholar
  • 5 Willie CK, Tzeng Y-C, Fisher JA, Ainslie PN. Integrative regulation of human brain blood flow. J Physiol 2014; 592 (05) 841-859
    CrossrefPubMedSuche in Google Scholar
  • 6 Roman RJ. P-450 metabolites of arachidonic acid in the control of cardiovascular function. Physiol Rev 2002; 82 (01) 131-185
    CrossrefPubMedSuche in Google Scholar
  • 7 Faraci FM, Heistad DD. Regulation of the cerebral circulation: role of endothelium and potassium channels. Physiol Rev 1998; 78 (01) 53-97
    CrossrefPubMedSuche in Google Scholar
  • 8 Minn A, Ghersi-Egea JF, Perrin R, Leininger B, Siest G. Drug metabolizing enzymes in the brain and cerebral microvessels. Brain Res Brain Res Rev 2019; 16 (01) 65-82
    CrossrefPubMedSuche in Google Scholar
  • 9 Tian R, Vogel P, Lassen NA, Mulvany MJ, Andreasen F, Aalkjaer C. Role of extracellular and intracellular acidosis for hypercapnia-induced inhibition of tension of isolated rat cerebral arteries. Circ Res 1995; 76 (02) 269-275
    CrossrefPubMedSuche in Google Scholar
  • 10 Makani S, Chesler M. Rapid rise of extracellular pH evoked by neural activity is generated by the plasma membrane calcium ATPase. J Neurophysiol 2010; 103 (02) 667-676
    CrossrefPubMedSuche in Google Scholar
  • 11 Lavi S, Gaitini D, Milloul V, Jacob G. Impaired cerebral CO2 vasoreactivity: association with endothelial dysfunction. Am J Physiol Heart Circ Physiol 2006; 291 (04) H1856-H1861
    CrossrefPubMedSuche in Google Scholar
  • 12 Phillips AA, Chan FH, Zheng MMZ, Krassioukov AV, Ainslie PN. Neurovascular coupling in humans: Physiology, methodological advances and clinical implications. J Cereb Blood Flow Metab 2016; 36 (04) 647-664
    CrossrefPubMedSuche in Google Scholar
  • 13 Attwell D, Buchan AM, Charpak S, Lauritzen M, Macvicar BA, Newman EA. Glial and neuronal control of brain blood flow. Nature 2010; 468 (7321): 232-243
    CrossrefPubMedSuche in Google Scholar
  • 14 Girouard H, Iadecola C. Neurovascular coupling in the normal brain and in hypertension, stroke, and Alzheimer disease. J Appl Physiol (1985) 2006; 100 (01) 328-335
    CrossrefPubMedSuche in Google Scholar
  • 15 Koehler RC, Roman RJ, Harder DR. Astrocytes and the regulation of cerebral blood flow. Trends Neurosci 2009; 32 (03) 160-169
    CrossrefPubMedSuche in Google Scholar
  • 16 Metea MR, Newman EA. Glial cells dilate and constrict blood vessels: a mechanism of neurovascular coupling. J Neurosci 2006; 26 (11) 2862-2870
    CrossrefPubMedSuche in Google Scholar
  • 17 Takata F, Dohgu S, Nishioku T. et al. Adrenomedullin-induced relaxation of rat brain pericytes is related to the reduced phosphorylation of myosin light chain through the cAMP/PKA signaling pathway. Neurosci Lett 2009; 449 (01) 71-75
    CrossrefPubMedSuche in Google Scholar
  • 18 Meves H. Arachidonic acid and ion channels: an update. Br J Pharmacol 2008; 155 (01) 4-16
    CrossrefPubMedSuche in Google Scholar
  • 19 Busija DW, Bari F, Domoki F, Louis T. Mechanisms involved in the cerebrovascular dilator effects of N-methyl-d-aspartate in cerebral cortex. Brain Res Brain Res Rev 2007; 56 (01) 89-100
    CrossrefPubMedSuche in Google Scholar
  • 20 Yang G, Chen G, Ebner TJ, Iadecola C. Nitric oxide is the predominant mediator of cerebellar hyperemia during somatosensory activation in rats. Am J Physiol 1999; 277 (06) R1760-R1770
    PubMedSuche in Google Scholar
  • 21 Puro DG. Physiology and pathobiology of the pericyte-containing retinal microvasculature: new developments. Microcirculation 2007; 14 (01) 1-10
    CrossrefPubMedSuche in Google Scholar
  • 22 Peppiatt CM, Howarth C, Mobbs P, Attwell D. Bidirectional control of CNS capillary diameter by pericytes. Nature 2006; 443 (7112): 700-704
    CrossrefPubMedSuche in Google Scholar
  • 23 Segal SS. Cell-to-cell communication coordinates blood flow control. Hypertension 1994; 23 (6, Pt 2): 1113-1120
    CrossrefPubMedSuche in Google Scholar
  • 24 Ngai AC, Winn HR. Modulation of cerebral arteriolar diameter by intraluminal flow and pressure. Circ Res 1995; 77 (04) 832-840
    CrossrefPubMedSuche in Google Scholar
  • 25 Hamel E. Perivascular nerves and the regulation of cerebrovascular tone. J Appl Physiol (1985) 2006; 100 (03) 1059-1064
    CrossrefPubMedSuche in Google Scholar
  • 26 Ainslie PN, Brassard P. Why is the neural control of cerebral autoregulation so controversial?. F1000Prime Rep 2014; 6: 14
    CrossrefPubMedSuche in Google Scholar
  • 27 Vasilopoulos D. Neurology: Compendium of Theory and Practise. Athens; Paschalidis: 2003
    Suche in Google Scholar
  • 28 Armstead WM. Cerebral blood flow autoregulation and dysautoregulation. Anesthesiol Clin 2016; 34 (03) 465-477
    CrossrefPubMedSuche in Google Scholar
  • 29 Budohoski KP, Czosnyka M, Smielewski P. et al. Impairment of cerebral autoregulation predicts delayed cerebral ischemia after subarachnoid hemorrhage: a prospective observational study. Stroke 2012; 43 (12) 3230-3237
    CrossrefPubMedSuche in Google Scholar
  • 30 Kwan J, Lunt M, Jenkinson D. Assessing dynamic cerebral autoregulation after stroke using a novel technique of combining transcranial Doppler ultrasonography and rhythmic handgrip. Blood Press Monit 2004; 9 (01) 3-8
    CrossrefPubMedSuche in Google Scholar
  • 31 Johnson U, Engquist H, Lewén A. et al. Increased risk of critical CBF levels in SAH patients with actual CPP below calculated optimal CPP. Acta Neurochir (Wien) 2017; 159 (06) 1065-1071
    CrossrefPubMedSuche in Google Scholar
  • 32 Kramer AH, Couillard PL, Zygun DA, Aries MJ, Gallagher CN. Continuous assessment of “optimal” cerebral perfusion pressure in traumatic brain injury: a cohort study of feasibility, reliability, and relation to outcome. Neurocrit Care 2019; 30 (01) 51-61
    CrossrefPubMedSuche in Google Scholar
  • 33 Donnelly J, Budohoski KP, Smielewski P, Czosnyka M. Regulation of the cerebral circulation: bedside assessment and clinical implications. Crit Care 2016; 20 (01) 129
    CrossrefPubMedSuche in Google Scholar