Impaired cerebral autoregulation: Measurement and application to stroke

Li Xiong, Xiuyun Liu, Ty Shang, Peter Smielewski, Joseph Donnelly, Zhen Ni Guo, Yi Yang, Thomas Leung, Marek Czosnyka, Rong Zhang, Jia Liu, Ka Sing Wong

Research output: Contribution to journalReview article

17 Scopus citations

Abstract

Cerebral autoregulation (CA) is a protective mechanism that maintains cerebral blood flow at a relatively constant level despite fluctuations of cerebral perfusion pressure or arterial blood pressure. It is a universal physiological mechanism that may involve myogenic, neural control as well as metabolic regulations of cerebral vasculature in response to changes in pressure or cerebral blood flow. Traditionally, CA has been represented by a sigmoid curve with a wide plateau between about 50 mm Hg and 170 mm Hg of steady-state changes in mean arterial pressure, defined as static CA. With the advent of transcranial Doppler, measurement of cerebral blood flow in response to transient changes in arterial pressure has been used to assess dynamic CA. However, a gold standard for measuring CA is not currently available. Stroke has been the leading cause of long-Term adult disability throughout the world. A better understanding of CA and its response to pathological derangements can help assess the severity of stroke, guide management decisions, assess response to interventions and provide prognostic information. The objective of this review is to provide a comprehensive insight about physiology of autoregulation, measurement methodologies and clinical applications in stroke to help build a consensus for what should be included in an internationally agreed protocol for CA testing and monitoring, and to promote its translation into clinical bedside practice for stroke management.

Original languageEnglish (US)
Pages (from-to)520-531
Number of pages12
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume88
Issue number6
DOIs
Publication statusPublished - Jun 1 2017

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Keywords

  • Cerebral autoregulation
  • cerebral blood flow
  • intracerebral haemorrhage
  • ischaemic stroke
  • transcranial Doppler

ASJC Scopus subject areas

  • Surgery
  • Arts and Humanities (miscellaneous)
  • Clinical Neurology
  • Psychiatry and Mental health

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