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
› Author Affiliations


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.

Publication History

Received: 24 September 2019

Accepted: 12 March 2020

Article published online:
14 February 2021

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