Skip to main content Accessibility help
×
Hostname: page-component-8448b6f56d-tj2md Total loading time: 0 Render date: 2024-04-20T00:49:09.570Z Has data issue: false hasContentIssue false

Chapter 2 - Cerebral Blood Flow Physiology and Metabolism in the Neurocritical Care Unit

Published online by Cambridge University Press:  24 July 2019

Michel T. Torbey
Affiliation:
Ohio State University
Get access

Summary

The brain has high energy requirements combined with an inability to store substrates critical for this tissue metabolism. This precarious balance results in a vital organ that is highly dependent on constant blood flow, providing oxygen and glucose via tissue perfusion. Although the brain only comprises 2% of total body weight, it receives 15% of cardiac output (700 ml/min) at rest, and accounts for 20% of oxygen consumption, and an even greater proportion of glucose utilization. Even brief interruptions in blood flow can trigger acute cerebral dysfunction, whether loss of consciousness from global hypoperfusion (e.g. syncope from non-perfusing cardiac arrhythmias or hypotension) or focal neurological deficits relating to ischemia from thromboembolism or vasospasm.

Type
Chapter
Information
Neurocritical Care , pp. 11 - 18
Publisher: Cambridge University Press
Print publication year: 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Melamed, E, Lavy, S, Bentin, S, Cooper, G, Rinot, Y (1980). Reduction in regional cerebral blood flow during normal aging in man. Stroke 11: 3135.CrossRefGoogle ScholarPubMed
Paulson, OB, Strandgaard, S, Edvinsson, L (1990). Cerebral autoregulation. Cerebrovasc Brain Metab Rev 2: 161192.Google Scholar
Strandgaard, S, Olesen, J, Skinhoj, E, Lassen, NA (1973). Autoregulation of brain circulation in severe arterial hypertension. Br Med J 1: 507510.Google Scholar
Bartynski, WS (2008). Posterior reversible encephalopathy syndrome, Part 2: controversies surrounding pathophysiology of vasogenic edema. AJNR 29: 10431049.Google Scholar
Davis, SM, Ackerman, RH, Correia, JA, et al. (1983). Cerebral blood flow and cerebrovascular CO2 reactivity in stroke-age normal controls. Neurology 33: 391399.Google Scholar
Brown, MM, Wade, JP, Marshall, J (1985). Fundamental importance of arterial oxygen content in the regulation of cerebral blood flow in man. Brain 108: 8193.CrossRefGoogle ScholarPubMed
Von Kummer, R, Scharf, J, Back, T, et al. (1988). Autoregulatory capacity and the effect of isovolemic hemodilution on local cerebral blood flow. Stroke 19: 594597.CrossRefGoogle ScholarPubMed
Webster, MW, Makaroun, MS, Steed, DL, et al. (1995). Compromised cerebral blood flow reactivity is a predictor of stroke in patients with symptomatic carotid artery occlusive disease. J Vasc Surg 21: 338344.Google Scholar
Symon, L, Branston, NM, Strong, AJ (1976). Autoregulation in acute focal ischemia: an experimental study. Stroke 7: 547554.Google Scholar
Yundt, KD, Grubb, RL Jr, Diringer, MN, Powers, WJ (1998). Autoregulatory vasodilation of parenchymal vessels is impaired during cerebral vasospasm. J Cereb Blood Flow Metab 18: 419424.Google Scholar
Van Mook, WNKA, Rennenberg, RJMW, Schurink, GW, et al. (2005). Cerebral hyperperfusion syndrome. Lancet Neurol 4: 877888.Google Scholar
Powers, WJ, Zazulia, A R, Videen, TO, et al. (2001). Autoregulation of cerebral blood flow surrounding acute (6 to 22 hours) intracerebral hemorrhage. Neurology 57: 1824.CrossRefGoogle ScholarPubMed
Powers, WJ, Videen, TO, Diringer, MN, Aiyagari, V, Zazulia, AR (2009). Autoregulation after ischaemic stroke. J Hypertens 27: 22182222.Google Scholar
Bandera, E, Botteri, M, Minelli, C, et al. (2006). Cerebral blood flow threshold of ischemic penumbra and infarct core in acute ischemic stroke: a systematic review. Stroke 37: 13341339.Google Scholar
Jones, TH, Morawetz, RB, Crowell, RM, et al. (1981). Thresholds of focal cerebral ischemia in awake monkeys. J Neurosurg 54: 773782.CrossRefGoogle ScholarPubMed
Siesjö, BK (2008). Pathophysiology and treatment of focal cerebral ischemia. Part I: pathophysiology. J Neurosurg 108: 616631.Google Scholar
Hossmann, KA (1994). Viability thresholds and the penumbra of focal ischemia. Ann Neurol 36: 557565.CrossRefGoogle ScholarPubMed
Baron, JC (2001). Mapping the ischaemic penumbra with PET: a new approach. Brain 124: 24.CrossRefGoogle ScholarPubMed
Derdeyn, CP, Videen, TO, Yundt, KD, et al. (2002). Variability of cerebral blood volume and oxygen extraction: stages of cerebral haemodynamic impairment revisited. Brain 125: 595607.Google Scholar
Powers, WJ, Grubb, RL Jr, Darriet, D, Raichle, ME (1985). Cerebral blood flow and cerebral metabolic rate of oxygen requirements for cerebral function and viability in humans. J Cereb Blood Flow Metab 5: 600608.CrossRefGoogle ScholarPubMed
Zazulia, AR, Diringer, MN, Videen, TO, et al. (2001). Hypoperfusion without ischemia surrounding acute intracerebral hemorrhage. J Cereb Blood Flow Metab 21: 804810.Google Scholar
Wise, RJ, Bernardi, S, Frackowiak, RS, Legg, NJ, Jones, T (1983). Serial observations on the pathophysiology of acute stroke: the transition from ischaemia to infarction as reflected in regional oxygen extraction. Brain 106 (Pt 1): 197222.Google Scholar
Baron, JC, Moseley, ME (2000). For how long is brain tissue salvageable?: imaging-based evidence. J Stroke Cerebrovasc Dis 9: 1520.Google Scholar
Zazulia, AR, Videen, TO, Powers, WJ (2007). Symptomatic autoregulatory failure in acute ischemic stroke. Neurology 68: 389390.Google Scholar
Chalela, J A, Dunn, B, Todd, JW, Warach, S (2005). Induced hypertension improves cerebral blood flow in acute ischemic stroke. Neurology 64: 1979.CrossRefGoogle ScholarPubMed
Uemura, K, Shishido, F, Higano, S, et al. (1986). Positron emission tomography in patients with a primary intracerebral hematoma. Acta Radiol Suppl 369: 426428.Google Scholar
Sills, C, Villar-Cordova, C, Pasteur, W, et al. (1996). Demonstration of hypoperfusion surrounding intracerebral hematoma in humans. J Stroke Cerebrovasc Dis 6: 1724.Google Scholar
Kim-Han, JS, Kopp, SJ, Dugan, LL, Diringer, MN (2006). Perihematomal mitochondrial dysfunction after intracerebral hemorrhage. Stroke 37: 24572462.CrossRefGoogle ScholarPubMed
Anderson, CS, Heeley, E, Huang, Y, et al. (2013). Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med 368: 23552365.CrossRefGoogle ScholarPubMed
Grubb, RL Jr, Raichle, MEME, Eichling, JOO, Gado, MHH, (1977). Effects of subarachnoid hemorrhage on cerebral blood volume, blood flow, and oxygen utilization in humans. J Neurosurg 46: 446453.Google Scholar
Meyer, CH, Lowe, D, Meyer, M, Richardson, PL, Neil-Dwyer, G (1983). Progressive change in cerebral blood flow during the first three weeks after subarachnoid hemorrhage. Neurosurgery 12: 5876.Google Scholar
Voldby, B, Enevoldsen, EM, Jensen, FT (1985). Regional CBF, intraventricular pressure, and cerebral metabolism in patients with ruptured intracranial aneurysms. J Neurosurg 62: 4858.CrossRefGoogle ScholarPubMed
Weir, B, Grace, M, Hansen, J, Rothberg, C (1978). Time course of vasospasm in man. J Neurosurg 48: 173178.Google Scholar
Dhar, R, Scalfani, MT, Blackburn, S (2012). Relationship between angiographic vasospasm and regional hypoperfusion in aneurysmal subarachnoid hemorrhage. Stroke 43: 17881794.Google Scholar
Carpenter, DA, Grubb, RL Jr, Tempel, LW, Powers, WJ (1991). Cerebral oxygen metabolism after aneurysmal subarachnoid hemorrhage. J Cereb Blood Flow Metab 11: 837844.Google Scholar
Brown, RJ, Kumar, A, Dhar, R, Sampson, TR, Diringer, MN (2013). The relationship between delayed infarcts and angiographic vasospasm after aneurysmal subarachnoid hemorrhage. Neurosurgery 72: 702708.Google Scholar
Jost, SC, Diringer, MN, Zazulia, AR, et al. (2005). Effect of normal saline bolus on cerebral blood flow in regions with low baseline flow in patients with vasospasm following subarachnoid hemorrhage. J Neurosurg 103: 2530.Google Scholar
Miller, JA, Dacey, RG, Diringer, MN (1995). Safety of hypertensive hypervolemic therapy with phenylephrine in the treatment of delayed ischemic deficits after subarachnoid hemorrhage. Stroke 26: 22602266.Google Scholar
Muench, E, Horn, P, Bauhuf, C, et al. (2007). Effects of hypervolemia and hypertension on regional cerebral blood flow, intracranial pressure, and brain tissue oxygenation after subarachnoid hemorrhage. Crit Care Med 35: 18441851.Google Scholar
Ekelund, A, Reinstrup, P, Ryding, E, et al. (2002). Effects of iso- and hypervolemic hemodilution on regional cerebral blood flow and oxygen delivery for patients with vasospasm after aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 144: 703712.Google Scholar
Dhar, R, Zazulia, AR, Videen, TO, et al. (2009). Red blood cell transfusion increases cerebral oxygen delivery in anemic patients with subarachnoid hemorrhage. Stroke 40: 30393044.Google Scholar
Dhar, R, Scalfani, MT, Zazulia, AR, et al. (2012). Comparison of induced hypertension, fluid bolus, and blood transfusion to augment cerebral oxygen delivery after subarachnoid hemorrhage. J Neurosurg 116: 648656.Google Scholar
Bouma, GJ, Muizelaar, JP, Choi, SC, Newlon, PG, Young, HF (1991). Cerebral circulation and metabolism after severe traumatic brain injury: the elusive role of ischemia. J Neurosurg 75: 685693.CrossRefGoogle ScholarPubMed
Coles, JP, Fryer, TD, Smielewski, P, et al. (2004). Incidence and mechanisms of cerebral ischemia in early clinical head injury. J Cereb Blood Flow Metab 24: 202211.Google Scholar
Hlatky, R, Contant, CF, Diaz-Marchan, P, Valadka, AB, Robertson, CS ( 2004). Significance of a reduced cerebral blood flow during the first 12 hours after traumatic brain injury. Neurocrit Care 1: 6983.CrossRefGoogle ScholarPubMed
Bouma, GJ, Muizelaar, JP, Bandoh, K, Marmarou, A (1992). Blood pressure and intracranial pressure-volume dynamics in severe head injury: relationship with cerebral blood flow. J Neurosurg 77: 1519.Google Scholar
Jaeger, M, Dengl, M, Meixensberger, J, Schuhmann, MU ( 2010). Effects of cerebrovascular pressure reactivity-guided optimization of cerebral perfusion pressure on brain tissue oxygenation after traumatic brain injury. Crit Care Med 38: 13431347.Google Scholar
Kety, SS, Schmidt, CF (1945). The determination of cerebral blood flow in man by the use of nitrous oxide in low concentrations. Am J Physiol 143: 5366.Google Scholar
Raichle, ME, Martin, WR, Herscovitch, P, Mintun, MA, Markham, J (1983). Brain blood flow measured with intravenous H2(15)O. II. Implementation and Validation. J Nucl Med 24: 790798.Google Scholar
Drayer, BP, Wolfson, SK, Boehnke, M, et al. (1978). Physiologic changes in regional cerebral blood flow defined by xenon-enhanced CT scanning. Neuroradiology 16: 220223.Google Scholar
Von Oettingen, G, Bergholt, B, Ostergaard, L, et al. (2000). Xenon CT cerebral blood flow in patients with head injury: influence of pulmonary trauma on the input function. Neuroradiology 42: 168173.CrossRefGoogle ScholarPubMed
Yonas, H, Sekhar, L, Johnson, DW, Gur, D (1989). Determination of irreversible ischemia by xenon-enhanced computed tomographic monitoring of cerebral blood flow in patients with symptomatic vasospasm. Neurosurgery 24: 368372.CrossRefGoogle ScholarPubMed
Rogg, J, Rutigliano, M, Yonas, H, et al. (1989). The acetazolamide challenge: imaging techniques designed to evaluate cerebral blood flow reserve. Am J Roentgenol 153: 605612.Google Scholar
Darby, JM, Yonas, H, Marks, EC, et al. (1994). Acute cerebral blood flow response to dopamine-induced hypertension after subarachnoid hemorrhage. J Neurosurg 80: 857864.Google Scholar
Harrigan, MR, Leonardo, J, Gibbons, KJ, Guterman, LR, Hopkins, LN (2005). CT perfusion cerebral blood flow imaging in neurological critical care. Neurocrit Care 2: 352366.Google Scholar
Chalela, JA, Alsop, DC, Gonzalez-Atavales, JB, et al. (2000). Magnetic resonance perfusion imaging in acute ischemic stroke using continuous arterial spin labeling. Stroke 31: 680687.Google Scholar
Zaharchuk, G (2014). Arterial spin-labeled perfusion imaging in acute ischemic stroke. Stroke 45: 12021207.Google Scholar
Vajkoczy, P, Horn, P, Thome, C, Munch, E, Schmiedek, P (2003). Regional cerebral blood flow monitoring in the diagnosis of delayed ischemia following aneurysmal subarachnoid hemorrhage. J Neurosurg 98: 12271234.Google Scholar
Clyde, BL, Resnick, DK, Yonas, H, Smith, HA, Kaufmann, AM (1996). The relationship of blood velocity as measured by transcranial doppler ultrasonography to cerebral blood flow as determined by stable xenon computed tomographic studies after aneurysmal subarachnoid hemorrhage. Neurosurgery 38: 896904; discussion 904–905.Google Scholar
Taussky, P, O’Neal, B, Daugherty, WP, et al. (2012). Validation of frontal near-infrared spectroscopy as noninvasive bedside monitoring for regional cerebral blood flow in brain-injured patients. Neurosurg Focus 32: E2.Google Scholar
Zweifel, C, Castellani, G, Czosnyka, M, et al. (2010). Continuous assessment of cerebral autoregulation with near-infrared spectroscopy in adults after subarachnoid hemorrhage. Stroke 41: 19631968.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×