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

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.



Publication History

Received: 24 September 2019

Accepted: 12 March 2020

Article published online:
14 February 2021

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  • References

  • 1 Sakas DE. Introduction to Neurosurgery. Athens: Parisianos; 2003
  • 2 Byrne JV. Control of cerebral blood flow. In: Tutorials in Endovascular Neurosurgery and Interventional Neuroradiology. Berlin: Springer; 2012: 83-96
  • 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
  • 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
  • 5 Willie CK, Tzeng Y-C, Fisher JA, Ainslie PN. Integrative regulation of human brain blood flow. J Physiol 2014; 592 (05) 841-859
  • 6 Roman RJ. P-450 metabolites of arachidonic acid in the control of cardiovascular function. Physiol Rev 2002; 82 (01) 131-185
  • 7 Faraci FM, Heistad DD. Regulation of the cerebral circulation: role of endothelium and potassium channels. Physiol Rev 1998; 78 (01) 53-97
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 15 Koehler RC, Roman RJ, Harder DR. Astrocytes and the regulation of cerebral blood flow. Trends Neurosci 2009; 32 (03) 160-169
  • 16 Metea MR, Newman EA. Glial cells dilate and constrict blood vessels: a mechanism of neurovascular coupling. J Neurosci 2006; 26 (11) 2862-2870
  • 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
  • 18 Meves H. Arachidonic acid and ion channels: an update. Br J Pharmacol 2008; 155 (01) 4-16
  • 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
  • 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
  • 21 Puro DG. Physiology and pathobiology of the pericyte-containing retinal microvasculature: new developments. Microcirculation 2007; 14 (01) 1-10
  • 22 Peppiatt CM, Howarth C, Mobbs P, Attwell D. Bidirectional control of CNS capillary diameter by pericytes. Nature 2006; 443 (7112): 700-704
  • 23 Segal SS. Cell-to-cell communication coordinates blood flow control. Hypertension 1994; 23 (6, Pt 2): 1113-1120
  • 24 Ngai AC, Winn HR. Modulation of cerebral arteriolar diameter by intraluminal flow and pressure. Circ Res 1995; 77 (04) 832-840
  • 25 Hamel E. Perivascular nerves and the regulation of cerebrovascular tone. J Appl Physiol (1985) 2006; 100 (03) 1059-1064
  • 26 Ainslie PN, Brassard P. Why is the neural control of cerebral autoregulation so controversial?. F1000Prime Rep 2014; 6: 14
  • 27 Vasilopoulos D. Neurology: Compendium of Theory and Practise. Athens; Paschalidis: 2003
  • 28 Armstead WM. Cerebral blood flow autoregulation and dysautoregulation. Anesthesiol Clin 2016; 34 (03) 465-477
  • 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
  • 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
  • 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
  • 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
  • 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