Cerebral pressure-flow relations in hypertensive elderly humans: transfer gain in different frequency domains.

The dynamics of the cerebral vascular response to blood pressure changes in hypertensive humans is poorly understood. Because cerebral blood flow is dependent on adequate perfusion pressure, it is important to understand the effect of hypertension on the transfer of pressure to flow in the cerebrovascular system of elderly people. Therefore, we examined the effect of spontaneous and induced blood pressure changes on beat-to-beat and within-beat cerebral blood flow in three groups of elderly people: normotensive, controlled hypertensive, and uncontrolled hypertensive subjects. Cerebral blood flow velocity (transcranial Doppler), blood pressure (Finapres), heart rate, and end-tidal CO(2) were measured during the transition from a sit to stand position. Transfer function gains relating blood pressure to cerebral blood flow velocity were assessed during steady-state sitting and standing. Cerebral blood flow regulation was preserved in all three groups by using changes in cerebrovascular resistance, transfer function gains, and the autoregulatory index as indexes of cerebral autoregulation. Hypertensive subjects demonstrated better attenuation of cerebral blood flow fluctuations in response to blood pressure changes both within the beat (i.e., lower gain at the cardiac frequency) and in the low-frequency range (autoregulatory, 0.03-0.07 Hz). Despite a better pressure autoregulatory response, hypertensive subjects demonstrated reduced reactivity to CO(2). Thus otherwise healthy hypertensive elderly subjects, whether controlled or uncontrolled with antihypertensive medication, retain the ability to maintain cerebral blood flow in the face of acute changes in perfusion pressure. Pressure regulation of cerebral blood flow is unrelated to cerebrovascular reactivity to CO(2).     

Cerebrovascular response to normal pregnancy: a longitudinal study

We used a longitudinal study design (gestational weeks 8, 15, 22, 29, and 36 and 12 wk postpartum ) to investigate the effect of normal pregnancy on cerebral autoregulation and pressor response. Blood flow velocities in the right internal carotid artery, end-tidal CO2, and mean arterial pressure (MAP) were simultaneously and continuously recorded in 16 healthy pregnant women during standardized hyperventilation and handgrip. Blood flow velocities were recorded using Doppler ultrasound sampled beat by beat using the ECG signal. The results demonstrate that the vasoconstrictor response to hyperventilation is unchanged during pregnancy. During standardized handgrip, MAP showed a statistically significant increase during pregnancy that did not affect cerebral blood flow. A statistically significant reduction in the MAP response to handgrip was seen in week 36. In conclusion, pregnancy has no impact on cerebral autoregulation. There is an impact on the pressor response resulting in a blunted reaction at week 36, probably caused by a fall in the baroreflex set point.     

Effect of sodium hydroxybutyrate on cerebral circulation and regional vasomotor reflexes

In experiments on cats it was found using electromagnetic and resistographic methods that sodium hydroxybutyrate (100 mg/kg) considerably increases cerebral circulation. The drug also potentiates the blood flow to the brain during formation of pressor reflexes of the arterial pressure. The blood flow increase is also observed in the system of femoral arteries while in the intestinal artery, on the contrary, there is a reduction in the blood flow increase during vasomotor reflexes. The reflex changes of the resistance in regional vessels are also different: the inhibition of pressor reflexes in the cerebral vessels along with their facilitation in the intestinal and femoral arteries and the potentiation of the reflex dilatatory phase in the limb vessels are seen. Different sensitivity to the drug of synaptic formations in the central links of various regional vasomotor reflexes is likely to underlie the difference described.     

Cerebral hemodynamic response to maximal exercise

The response of central and cerebral hemodynamics to a stepwise increase in dynamic exercise until failure was studied in healthy young men. Each subject was examined using Doppler ultrasound assessment of blood flow in the middle cerebral artery (MCA), Doppler echocardiography, and spiroergometry. Hemodynamic parameters were recorded before the study and during the last several seconds of each step of the dynamic exercise. The central hemodynamic and energy exchange parameters exhibited typical changes with increasing exercise intensity. The peak systolic blood flow velocity in the MCA increased only in response to exercise of a moderate intensity (1 W/kg body weight, 45% of the maximal oxygen uptake); the further increase in exercise intensity did not affect the blood flow velocity. The cerebral vascular resistance index at the last step of the exercise was 24% higher than at rest. The increase in the MCA resistance index during the exercise was moderately correlated with the increase in the pulse pressure and systolic blood pressure, whereas the increase in blood pressure was not related to the increase in the peak systolic blood flow velocity in the MCA in response to an exercise intensity at which the oxygen uptake was higher than 45% of its maximal value. The differences between the responses of central and cerebral hemodynamics to the stepwise increase in exercise intensity reflect the phenomenon of cerebral hemodynamic autoregulation.     

Emesis, radiation exposure, and local cerebral blood flow in the ferret

We examined the sensitivity of the ferret to emetic stimuli and the effect of radiation exposure near the time of emesis on local cerebral blood flow. Ferrets vomited following the administration of either apomorphine (approx 45% of the ferrets tested) or peptide YY (approx 36% of those tested). Exposure to radiation was a very potent emetic stimulus, but vomiting could be prevented by restraint of the hindquarters of the ferret. Local cerebral blood flow was measured using a quantitative autoradiographic technique and with the exception of several regions in the telencephalon and cerebellum, local cerebral blood flow in the ferret was similar to that in the rat. In animals with whole-body exposure to moderate levels of radiation (4 Gy of 137Cs), mean arterial blood pressure was similar to that in the control group. However, 15-25 min following irradiation there was a general reduction of local cerebral blood flow ranging from 7 to 33% of that in control animals. These cerebral blood flow changes likely correspond to a reduced activation of the central nervous system.     

Responses of central and cerebral hemodynamics to active orthostasis in healthy subjects

Regular trends in changes in cerebral and central hemodynamics were studied in 28 healthy men aged 20–26 years during active orthostatic stress. The hemodynamic parameters of the blood flow in the middle cerebral artery (MCA), systemic hemodynamics, and parameters of pulmonary ventilation were recorded simultaneously for 10 min while a subject was in a horizontal position and for the same period after the position had been changed to vertical (active rising). In healthy subjects, several types of responses of cerebral and central hemodynamics were detected during active orthostasis.     

Relationships between Cerebral Blood Flow Dynamics and Bioelectric Activity of the Human Brain in Experimental Acute Hypoxia

The relationships between the parameters of oxygen content in the body (hemoglobin saturation with oxygen and trancutaneous oxygen tension), central hemodynamics (cardiac output), and cerebral hemodynamics (cerebral blood flow rate) were studied during a hypoxic test (inhalation of an oxygen–nitrogen mixture containing 8% oxygen for 15 min). Special attention was paid to the relationships between the dynamics of cerebral blood flow and cerebral bioelectric activity measured by EEG parameters. It was demonstrated that the trancutaneous oxygen tension decreased to a greater extent than the hemoglobin saturation with oxygen and the cerebral blood flow increased to a greater extent than the cardiac output. The increase in cerebral blood flow and the increase in the indices and power of and EEG waves in the course of hypoxia were strongly positively correlated with each other in most subjects. However, if these parameters were considered in the series of subjects, the degree of the increase in the indices and power of and waves in different subjects was negatively correlated with the increase in the cerebral blood flow. The results are explained in terms of redistribution of blood flow in the body to provide a better oxygen supply to the brain and optimization of the ratios between the cerebral oxygen consumption and the functional load on the system of oxygen supply.     

Variation of technological adaptability evaluated by the performance and brain hemodynamics measurement

This paper investigates the applicability of cerebral blood flow in evaluating the technological adaptability for operating industrial products. The procedure of the experiment was explained to the subjects and informed consent was obtained from them. Twenty male and twenty female subjects (19-22 yrs) operated the destination setting task of a car navigation system. Subjects were divided into two sub groups to operate tasks of model A and model B of a car navigation system. Operation time of tasks and cerebral blood flow of frontal region were measured during tasks. Non-invasive measuring of regional cerebral blood flow was estimated by measuring deoxygenated hemoglobin, oxygenated hemoglobin, and total haemoglobin using the time resolved spectroscopy (TRS). Females were faster than males in operating the task of setting the destination searched by street address. Total haemoglobin of male subjects was significantly higher than that of females during resting and tasks. Changes of cerebral blood flow were observed during operating a car navigation system. In this paper we discussed the possibility of physiological evaluation for technological adaptability by means of the performance and brain hemodynamics measurement.     

Effect of peripheral and central alpha-adrenoceptor blockade on cerebral microvascular and blood flow responses to hypoxia.

The purpose of this study was to evaluate the effects of vascular and central alpha-adrenoceptor blockade on cerebral blood flow (CBF) and utilization of brain arteriolar and capillary reserve in conscious rats during normoxia and hypoxia (8% O2 in N2). Animals were divided into three groups and administered either saline, N-methyl chlorpromazine (does not cross the blood-brain barrier), or phenoxybenzamine (crosses the blood-brain barrier) in equipotent doses. Neither agent affected regional CBF and the utilization of brain microvascular reserve during normoxia. CBF increased from 70.9 +/- 2.9 (SEM) ml/min/100 g in the control normoxic group to 123.8 +/- 4.2 ml/min/100 g in control hypoxic animals. In control, hypoxic flow to pons and medulla of the brain was higher than to cortex, hypothalamus or thalamus. The percent of arterioles/mm2 perfused increased from 49.6 +/- 2.0% during control normoxia to 65.6 +/- 3.0% during control hypoxia. The percentage of capillaries/mm2 perfused changed similarly. Hypoxic CBF was increased similarly after administration of N-methyl chlorpromazine or phenoxybenzamine. Administration of N-methyl chlorpromazine or phenoxybenzamine eliminated regional differences in hypoxic CBF and the utilization of arterioles, and did not affect capillary response. There was no difference between the effect of N-methyl chlorpromazine and phenoxybenzamine on cerebral microvascular and blood flow responses to hypoxia. It was concluded that peripheral alpha-adrenoceptors affect the distribution of regional microvascular and blood flow responses to hypoxia, and central alpha-adrenoceptors probably do not participate in this effect.     

Cerebral perturbations during exercise in hypoxia

Reduction of aerobic exercise performance observed under hypoxic conditions is mainly attributed to altered muscle metabolism due to impaired O(2) delivery. It has been recently proposed that hypoxia-induced cerebral perturbations may also contribute to exercise performance limitation. A significant reduction in cerebral oxygenation during whole body exercise has been reported in hypoxia compared with normoxia, while changes in cerebral perfusion may depend on the brain region, the level of arterial oxygenation and hyperventilation induced alterations in arterial CO(2). With the use of transcranial magnetic stimulation, inconsistent changes in cortical excitability have been reported in hypoxia, whereas a greater impairment in maximal voluntary activation following a fatiguing exercise has been suggested when arterial O(2) content is reduced. Electromyographic recordings during exercise showed an accelerated rise in central motor drive in hypoxia, probably to compensate for greater muscle contractile fatigue. This accelerated development of muscle fatigue in moderate hypoxia may be responsible for increased inhibitory afferent signals to the central nervous system leading to impaired central drive. In severe hypoxia (arterial O(2) saturation <70-75%), cerebral hypoxia per se may become an important contributor to impaired performance and reduced motor drive during prolonged exercise. This review examines the effects of acute and chronic reduction in arterial O(2) (and CO(2)) on cerebral blood flow and cerebral oxygenation, neuronal function, and central drive to the muscles. Direct and indirect influences of arterial deoxygenation on central command are separated. Methodological concerns as well as future research avenues are also considered.     

Subarachnoid haemorrhage: older patients have low cerebral blood flow.

Daily estimations of hemispheral cerebral blood flow using the xenon-133 inhalation technique was made in 116 patients during the first three weeks after subarachnoid haemorrhage. The patients'' cerebral perfusion on average remained less than the normal perfusion expected for their age (based on a single estimation of cerebral blood flow in 67 volunteers). On each separate day after subarachnoid haemorrhage cerebral blood flow was inversely related to the patient''s age. Older patients seem especially at risk of developing cerebral ischaemia after subarachnoid haemorrhage. The clinical outcome was more often unfavourable in older patients--that is, in those who tended to have the lowest cerebral blood flow. Present results support the view that episodes of low cerebral blood flow lead to a poor outcome after subarachnoid haemorrhage. Because of the risk of inducing cerebral ischaemia great care should be exercised by physicians administering hypotensive drugs to older patients after subarachnoid haemorrhage.     

Middle cerebral artery blood velocity during intense static exercise is dominated by a Valsalva maneuver.

Lifting of a heavy weight may lead to "blackout" and occasionally also to cerebral hemorrhage, indicating pronounced consequences for the blood flow through the brain. We hypothesized that especially strenuous respiratory straining (a Valsalva-like maneuver) associated with intense static exercise would lead to a precipitous rise in mean arterial and central venous pressures and, in turn, influence the middle cerebral artery blood velocity (MCA V(mean)) as a noninvasive indicator of changes in cerebral blood flow. In 10 healthy subjects, MCA V(mean) was evaluated in response to maximal static two-legged exercise performed either with a concomitantly performed Valsalva maneuver or with continued ventilation and also during a Valsalva maneuver without associated exercise (n = 6). During static two-legged exercise, the largest rise for mean arterial pressure and MCA V(mean) was established at the onset of exercise performed with a Valsalva-like maneuver (by 42 +/- 5 mmHg and 31 +/- 3% vs. 22 +/- 6 mmHg and 25 +/- 6% with continued ventilation; P < 0.05). Profound reductions in MCA V(mean) were observed both after exercise with continued ventilation (-29 +/- 4% together with a reduction in the arterial CO(2) tension by -5 +/- 1 Torr) and during the maintained Valsalva maneuver (-21 +/- 3% together with an elevation in central venous pressure to 40 +/- 7 mmHg). Responses to performance of the Valsalva maneuver with and without exercise were similar, reflecting the deterministic importance of the Valsalva maneuver for the central and cerebral hemodynamic response to intense static exercise. Continued ventilation during intense static exercise may limit the initial rise in arterial pressure and may in turn reduce the risk of hemorrhage. On the other hand, blackout during and after intense static exercise may reflect a reduction in cerebral blood flow due to expiratory straining and/or hyperventilation.     

The role of exosomes in stroke

Molecular Biology Reports - Stroke is induced by a partial disruption of cerebral blood flow to the brain and is related to high morbidity and mortality. In the central nervous system, exosomes...     

The regulation of the cerebral circulation in long lasting bradycardia

In the course of long lasting bradycardia in elderly patients, cardiac output will regularly diminish, circulation will slow down and signs of cerebral insufficiency may become manifest. The changes of cerebral circulation and its regulation were studied in 10 patients 61-74 years of age, with restricted cerebral regulatory capacity, suffering from permanent bradycardia. Cerebral blood flow was measured by using the venous isotope dilution technique by double punctures of the internal jugular vein. Hemispheric cerebral blood flow, cerebral O2 consumption and cerebral vascular resistance were determined during bradycardia and after termination of bradycardia by pacemaker. During long lasting bradycardia, cerebral blood flow and cerebral O2 consumption decreased, cerebral vascular resistance was elevated. After pacemaker implantation, cerebral blood flow and O2 consumption increased and cerebral vascular resistance decreased, approaching the normal value. The symptoms of cerebral insufficiency disappeared on improvement of the cerebral circulation.     

Electroencephalograms and cerebral blood flow in carp, Cyprinus carpio, subjected to acute hypoxia

Changes in electroencephalogams (EEG) and cerebral blood flow were examined in carp immobilized with a muscle relaxant during 60 min hypoxia (water Po ₂ of approximately 20 mmHg) and subsequent 30 min normoxia. The amplitude of EEG waves recorded from the telencephalon decreased gradually but slightly with the progression of hypoxia, whereas the telencephalic blood flow increased mainly due to an increased blood velocity. These findings suggested that cerebral activity during hypoxia was compensated to some degree by increased cerebral blood flow. However, carp showed large variations in the patterns of EEG responses and cerebral blood flow.     

The "black hole" phenomenon in ultrasonic backscattering measurement under pulsatile flow with porcine whole blood in a rigid tube

The "black hole" phenomenon was further investigated with porcine whole blood under pulsatile flow conditions in a straight rigid tube 120 cm long and of 0.95 cm diameter. A modified Aloka 280 commercial scanner with a 7.5 MHz linear array was used to collect the radio frequency (RF) signal of backscattering echoes from the blood inside the tube. The transducer was located downstream from the entrance and parallel to the longitudinal direction of the tube. The experimental results showed that higher hematocrits enhanced the black hole phenomenon, leading to a more apparent and larger diameter black hole. The black hole was not apparent at hematocrits below 23%. The highest hematocrit used in the experiment was 60%. Beat rates of 20, 40 and 60 beats per minute (bpm) were used, and the black hole became weaker in amplitude and smaller in diameter when the peak flow velocity was increased at each beat rate. These results are consistent with the suggestion in previous work that the black hole arises from insufficient aggregation of red blood cells (RBCs) at the center of the tube because of the low shear rate. At 20 and 40 bpm, the peak flow velocity ranges were 10 approximately 25 cm/s and 18 approximately 27 cm/s, respectively. The black hole was very clear at the minimal peak flow velocity but almost disappeared at the maximal velocities for each beat rate. At 60 bpm, experiments were only performed at one peak flow velocity of 31 cm/s and the black hole was clear. The results showed that the black hole was more pronounced at higher beat rates when the peak velocity was the same. This phenomenon cannot be explained by previous hypotheses. Acceleration seems to be the only flow parameter that varies at different beat rates when peak velocities are the same. Therefore, the influence of acceleration on the structural organization and orientation of RBC rouleaux might be another factor involved in the formation of the black hole in addition to the shear rate. As the entrance length was changed from 110 to 15 diameters (D) in seven steps at the hematocrit of 60%, it was found that a position farther downstream yielded a black hole with a greater contrast relative to the surrounding region, while the backscattering power at the central hypoechoic zone did not increase with increasing entrance length.     

Non-Linear Characterisation of Cerebral Pressure-Flow Dynamics in Humans

Cerebral metabolism is critically dependent on the regulation of cerebral blood flow (CBF), so it would be expected that vascular mechanisms that play a critical role in CBF regulation would be tightly conserved across individuals. However, the relationships between blood pressure (BP) and cerebral blood velocity fluctuations exhibit inter-individual variations consistent with heterogeneity in the integrity of CBF regulating systems. Here we sought to determine the nature and consistency of dynamic cerebral autoregulation (dCA) during the application of oscillatory lower body negative pressure (OLBNP). In 18 volunteers we recorded BP and middle cerebral artery blood flow velocity (MCAv) and examined the relationships between BP and MCAv fluctuations during 0.03, 0.05 and 0.07Hz OLBNP. dCA was characterised using project pursuit regression (PPR) and locally weighted scatterplot smoother (LOWESS) plots. Additionally, we proposed a piecewise regression method to statistically determine the presence of a dCA curve, which was defined as the presence of a restricted autoregulatory plateau shouldered by pressure-passive regions. Results show that LOWESS has similar explanatory power to that of PPR. However, we observed heterogeneous patterns of dynamic BP-MCAv relations with few individuals demonstrating clear evidence of a dCA central plateau. Thus, although BP explains a significant proportion of variance, dCA does not manifest as any single characteristic BP-MCAv function.     

Brain activation by central command during actual and imagined handgrip under hypnosis.

The purpose was to compare patterns of brain activation during imagined handgrip exercise and identify cerebral cortical structures participating in "central" cardiovascular regulation. Subjects screened for hypnotizability, five with higher (HH) and four with lower hypnotizability (LH) scores, were tested under two conditions involving 3 min of 1) static handgrip exercise (HG) at 30% of maximal voluntary contraction (MVC) and 2) imagined HG (I-HG) at 30% MVC. Force (kg), forearm integrated electromyography, rating of perceived exertion, heart rate (HR), mean blood pressure (MBP), and differences in regional cerebral blood flow distributions were compared using an ANOVA. During HG, both groups showed similar increases in HR (+13 +/- 5 beats/min) and MBP (+17 +/- 3 mmHg) after 3 min. However, during I-HG, only the HH group showed increases in HR (+10 +/- 2 beats/min; P < 0.05) and MBP (+12 +/- 2 mmHg; P < 0.05). There were no significant increases or differences in force or integrated electromyographic activity between groups during I-HG. The rating of perceived exertion was significantly increased for the HH group during I-HG, but not for the LH group. In comparison of regional cerebral blood flow, the LH showed significantly lower activity in the anterior cingulate (-6 +/- 2%) and insular cortexes (-9 +/- 4%) during I-HG. These findings suggest that cardiovascular responses elicited during imagined exercise involve central activation of insular and anterior cingulate cortexes, independent of muscle afferent feedback; these structures appear to have key roles in the central modulation of cardiovascular responses.     

The Effects of Involuntary Respiratory Contractions on Cerebral Blood Flow during Maximal Apnoea in Trained Divers

The effects of involuntary respiratory contractions on the cerebral blood flow response to maximal apnoea is presently unclear. We hypothesised that while respiratory contractions may augment left ventricular stroke volume, cardiac output and ultimately cerebral blood flow during the struggle phase, these contractions would simultaneously cause marked ‘respiratory’ variability in blood flow to the brain. Respiratory, cardiovascular and cerebrovascular parameters were measured in ten trained, male apnoea divers during maximal ‘dry’ breath holding. Intrathoracic pressure was estimated via oesophageal pressure. Left ventricular stroke volume, cardiac output and mean arterial pressure were monitored using finger photoplethysmography, and cerebral blood flow velocity was obtained using transcranial ultrasound. The increasingly negative inspiratory intrathoracic pressure swings of the struggle phase significantly influenced the rise in left ventricular stroke volume (R ² = 0.63, P<0.05), thereby contributing to the increase in cerebral blood flow velocity throughout this phase of apnoea. However, these contractions also caused marked respiratory variability in left ventricular stroke volume, cardiac output, mean arterial pressure and cerebral blood flow velocity during the struggle phase (R ² = 0.99, P<0.05). Interestingly, the magnitude of respiratory variability in cerebral blood flow velocity was inversely correlated with struggle phase duration (R ² = 0.71, P<0.05). This study confirms the hypothesis that, on the one hand, involuntary respiratory contractions facilitate cerebral haemodynamics during the struggle phase while, on the other, these contractions produce marked respiratory variability in blood flow to the brain. In addition, our findings indicate that such variability in cerebral blood flow negatively impacts on struggle phase duration, and thus impairs breath holding performance.     

Human Skin Hypoxia Modulates Cerebrovascular and Autonomic Functions

Because the skin is an oxygen sensor in amphibians and mice, we thought to confirm this function also in humans. The human upright posture, however, introduces additional functional demands for the maintenance of oxygen homeostasis in which cerebral blood flow and autonomic nervous system (ANS) function may also be involved. We examined nine males and three females. While subjects were breathing ambient air, at sea level, we changed gases in a plastic body-bag during two conditions of the experiment such as to induce skin hypoxia (with pure nitrogen) or skin normoxia (with air). The subjects performed a test of hypoxic ventilatory drive during each condition of the experiment. We found no differences in the hypoxic ventilatory drive tests. However, ANS function and cerebral blood flow velocities were modulated by skin hypoxia and the effect was significantly greater on the left than right middle cerebral arteries. We conclude that skin hypoxia modulates ANS function and cerebral blood flow velocities and this might impact life styles and tolerance to ambient hypoxia at altitude. Thus the skin in normal humans, in addition to its numerous other functions, is also an oxygen sensor.