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.
- Cerebral autoregulation
- ischaemic stroke
- intracerebral haemorrhage
- cerebral blood flow
- transcranial Doppler
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Contributors LX, XL and TS performed the literature search and wrote the manuscript. JL and KSW conceived and designed the review outlines. JL, MC and RZ helped revise the manuscript. PS and JD proposed professional advice on the methodologies of the assessment of cerebral autoregulation. ZG, YY and TL proposed professional advice on the clinical research related to cerebral autoregulation in ischaemic stroke.
Funding This work was supported by the Health and Medical Research Fund (HMRF, Project No 02130836) and the General Research Fund from Research Grants Council (GRF, Reference No. 14100215) in Hong Kong.
Competing interests None declared.
Provenance and peer review Commissioned; externally peer reviewed.
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