RT Journal Article
SR Electronic
T1 Impaired cerebral autoregulation: measurement and application to stroke
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP 520
OP 531
DO 10.1136/jnnp-2016-314385
VO 88
IS 6
A1 Li Xiong
A1 Xiuyun Liu
A1 Ty Shang
A1 Peter Smielewski
A1 Joseph Donnelly
A1 Zhen-ni Guo
A1 Yi Yang
A1 Thomas Leung
A1 Marek Czosnyka
A1 Rong Zhang
A1 Jia Liu
A1 Ka Sing Wong
YR 2017
UL http://jnnp.bmj.com/content/88/6/520.abstract
AB 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.