Cerebral circulation is the movement of
blood
Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood in the c ...
through a network of
cerebral arteries
The cerebral arteries describe three main pairs of arteries and their branches, which perfuse the cerebrum of the brain.
The three main arteries are the:
* '' Anterior cerebral artery'' (ACA)
* ''Middle cerebral artery
The middle cerebral arte ...
and
veins
Veins are blood vessels in humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated b ...
supplying the
brain
A brain is an organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is located in the head, usually close to the sensory organs for senses such as vision. It is the most complex organ in a v ...
. The rate of cerebral
blood flow
Hemodynamics or haemodynamics are the dynamics of blood flow. The circulatory system is controlled by homeostatic mechanisms of autoregulation, just as hydraulic circuits are controlled by control systems. The hemodynamic response continuously m ...
in an adult
human
Humans (''Homo sapiens'') are the most abundant and widespread species of primate, characterized by bipedalism and exceptional cognitive skills due to a large and complex brain. This has enabled the development of advanced tools, culture, ...
is typically 750
milliliter
The litre (international spelling) or liter (American English spelling) (SI symbols L and l, other symbol used: ℓ) is a metric unit of volume. It is equal to 1 cubic decimetre (dm3), 1000 cubic centimetres (cm3) or 0.001 cubic metre (m3). ...
s per
minute
The minute is a unit of time usually equal to (the first sexagesimal fraction) of an hour, or 60 seconds. In the UTC time standard, a minute on rare occasions has 61 seconds, a consequence of leap seconds (there is a provision to insert a nega ...
, or about 15% of
cardiac output
In cardiac physiology, cardiac output (CO), also known as heart output and often denoted by the symbols Q, \dot Q, or \dot Q_ , edited by Catherine E. Williamson, Phillip Bennett is the volumetric flow rate of the heart's pumping output: t ...
.
Arteries
An artery (plural arteries) () is a blood vessel in humans and most animals that takes blood away from the heart to one or more parts of the body (tissues, lungs, brain etc.). Most arteries carry oxygenated blood; the two exceptions are the pu ...
deliver
oxygenated blood,
glucose
Glucose is a simple sugar with the molecular formula . Glucose is overall the most abundant monosaccharide, a subcategory of carbohydrates. Glucose is mainly made by plants and most algae during photosynthesis from water and carbon dioxide, using ...
and other nutrients to the brain.
Vein
Veins are blood vessels in humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated b ...
s carry "used or spent" blood back to the
heart
The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide t ...
, to remove
carbon dioxide
Carbon dioxide (chemical formula ) is a chemical compound made up of molecules that each have one carbon atom covalently double bonded to two oxygen atoms. It is found in the gas state at room temperature. In the air, carbon dioxide is transpar ...
,
lactic acid
Lactic acid is an organic acid. It has a molecular formula . It is white in the solid state and it is miscible with water. When in the dissolved state, it forms a colorless solution. Production includes both artificial synthesis as well as natu ...
, and other
metabolic
Metabolism (, from el, μεταβολή ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run cell ...
products.
Because the
brain
A brain is an organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is located in the head, usually close to the sensory organs for senses such as vision. It is the most complex organ in a v ...
would quickly suffer damage from any stoppage in blood supply, the cerebral circulatory system has safeguards including
autoregulation
Autoregulation is a process within many biological systems, resulting from an internal adaptive mechanism that works to adjust (or mitigate) that system's response to stimuli. While most systems of the body show some degree of autoregulation, it ...
of the
blood vessel
The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide away ...
s. The failure of these safeguards may result in a
stroke
A stroke is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both cause parts of the brain to stop functionin ...
. The
volume
Volume is a measure of occupied three-dimensional space. It is often quantified numerically using SI derived units (such as the cubic metre and litre) or by various imperial or US customary units (such as the gallon, quart, cubic inch). The de ...
of blood in circulation is called the
cerebral blood flow
Cerebral circulation is the movement of blood through a network of cerebral arteries and veins supplying the brain. The rate of cerebral blood flow in an adult human is typically 750 milliliters per minute, or about 15% of cardiac output. Arterie ...
. Sudden intense accelerations change the
gravitational forces perceived by bodies and can severely
impair cerebral circulation and normal functions to the point of becoming serious life-threatening conditions.
The following description is based on idealized human cerebral circulation. The pattern of circulation and its
nomenclature
Nomenclature (, ) is a system of names or terms, or the rules for forming these terms in a particular field of arts or sciences. The principles of naming vary from the relatively informal naming conventions, conventions of everyday speech to the i ...
vary between organisms.
Anatomy
![Cerebrovascular System](https://upload.wikimedia.org/wikipedia/commons/d/d5/Cerebrovascular_System.png)
Blood supply
Blood supply to the brain is normally divided into anterior and posterior segments, relating to the different arteries that supply the brain. The two main pairs of arteries are the
Internal carotid arteries
The internal carotid artery (Latin: arteria carotis interna) is an artery in the neck which supplies the anterior circulation of the brain. In human anatomy, the internal and external carotids arise from the common carotid arteries, where these ...
(supply the anterior brain) and
vertebral arteries
The vertebral arteries are major arteries of the neck. Typically, the vertebral arteries originate from the subclavian arteries. Each vessel courses superiorly along each side of the neck, merging within the skull to form the single, midline ba ...
(supplying the
brainstem
The brainstem (or brain stem) is the posterior stalk-like part of the brain that connects the cerebrum with the spinal cord. In the human brain the brainstem is composed of the midbrain, the pons, and the medulla oblongata. The midbrain is cont ...
and posterior brain).. The anterior and posterior cerebral circulations are interconnected via bilateral
posterior communicating arteries
In human anatomy, the left and right posterior communicating arteries are arteries at the base of the brain that form part of the circle of Willis
The circle of Willis (also called Willis' circle, loop of Willis, cerebral arterial circle, and W ...
. They are part of the
Circle of Willis
The circle of Willis (also called Willis' circle, loop of Willis, cerebral arterial circle, and Willis polygon) is a circulatory anastomosis that supplies blood to the brain and surrounding structures in reptiles, birds and mammals, including huma ...
, which provides backup circulation to the brain. In case one of the supply arteries is occluded, the Circle of Willis provides interconnections between the anterior and the posterior cerebral circulation along the floor of the cerebral vault, providing blood to tissues that would otherwise become
ischemic
Ischemia or ischaemia is a restriction in blood supply to any tissue, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism (to keep tissue alive). Ischemia is generally caused by problems w ...
.
Anterior cerebral circulation
![Gray514](https://upload.wikimedia.org/wikipedia/commons/c/ce/Gray514.png)
The anterior cerebral circulation is the blood supply to the anterior portion of the brain including
eyes. It is supplied by the following arteries:
*
Internal carotid arteries
The internal carotid artery (Latin: arteria carotis interna) is an artery in the neck which supplies the anterior circulation of the brain. In human anatomy, the internal and external carotids arise from the common carotid arteries, where these ...
: These large arteries are the medial branches of the
common carotid arteries
In anatomy, the left and right common carotid arteries (carotids) (Entry "carotid"
in
external carotid
The external carotid artery is a major artery of the head and neck. It arises from the common carotid artery when it splits into the external and internal carotid artery. External carotid artery supplies blood to the face and neck.
Structure
Th ...
branches which supply the facial tissues; the internal carotid artery branches into the
anterior cerebral artery
The anterior cerebral artery (ACA) is one of a pair of cerebral arteries that supplies oxygenated blood to most midline portions of the frontal lobes and superior medial parietal lobes of the brain. The two anterior cerebral arteries arise from t ...
and continues to form the
middle cerebral artery
The middle cerebral artery (MCA) is one of the three major paired cerebral artery, cerebral arteries that supply blood to the cerebrum. The MCA arises from the internal carotid artery and continues into the lateral sulcus where it then branches an ...
.
*
Anterior cerebral artery
The anterior cerebral artery (ACA) is one of a pair of cerebral arteries that supplies oxygenated blood to most midline portions of the frontal lobes and superior medial parietal lobes of the brain. The two anterior cerebral arteries arise from t ...
(ACA)
**
Anterior communicating artery
In human anatomy, the anterior communicating artery is a blood vessel of the brain that connects the left and right anterior cerebral arteries.
Anatomy
The anterior communicating artery connects the two anterior cerebral arteries across the comm ...
: Connects both anterior cerebral arteries, within and along the floor of the cerebral vault.
*
Middle cerebral artery
The middle cerebral artery (MCA) is one of the three major paired cerebral artery, cerebral arteries that supply blood to the cerebrum. The MCA arises from the internal carotid artery and continues into the lateral sulcus where it then branches an ...
(MCA)
Posterior cerebral circulation
![Circle of Willis en](https://upload.wikimedia.org/wikipedia/commons/2/2e/Circle_of_Willis_en.svg)
The posterior cerebral circulation is the blood supply to the posterior portion of the brain, including the
occipital lobe
The occipital lobe is one of the four major lobes of the cerebral cortex in the brain of mammals. The name derives from its position at the back of the head, from the Latin ''ob'', "behind", and ''caput'', "head".
The occipital lobe is the vi ...
s,
cerebellum
The cerebellum (Latin for "little brain") is a major feature of the hindbrain of all vertebrates. Although usually smaller than the cerebrum, in some animals such as the mormyrid fishes it may be as large as or even larger. In humans, the cerebel ...
and
brainstem
The brainstem (or brain stem) is the posterior stalk-like part of the brain that connects the cerebrum with the spinal cord. In the human brain the brainstem is composed of the midbrain, the pons, and the medulla oblongata. The midbrain is cont ...
.
It is supplied by the following arteries:
*
Vertebral arteries
The vertebral arteries are major arteries of the neck. Typically, the vertebral arteries originate from the subclavian arteries. Each vessel courses superiorly along each side of the neck, merging within the skull to form the single, midline ba ...
: These smaller arteries branch from the
subclavian arteries
In human anatomy, the subclavian arteries are paired major arteries of the upper thorax, below the clavicle. They receive blood from the aortic arch. The left subclavian artery supplies blood to the left arm and the right subclavian artery supplie ...
which primarily supply the shoulders, lateral chest, and arms. Within the
cranium
The skull is a bone protective cavity for the brain. The skull is composed of four types of bone i.e., cranial bones, facial bones, ear ossicles and hyoid bone. However two parts are more prominent: the cranium and the mandible. In humans, the ...
the two vertebral arteries fuse into the
basilar artery
The basilar artery () is one of the arteries that supplies the brain with oxygen-rich blood.
The two vertebral arteries and the basilar artery are known as the vertebral basilar system, which supplies blood to the posterior part of the circle of W ...
.
**
Posterior inferior cerebellar artery
The posterior inferior cerebellar artery (PICA) is the largest branch of the vertebral artery. It is one of the three main arteries that supply blood to the cerebellum, a part of the brain. Blockage of the posterior inferior cerebellar artery can r ...
(PICA)
*
Basilar artery
The basilar artery () is one of the arteries that supplies the brain with oxygen-rich blood.
The two vertebral arteries and the basilar artery are known as the vertebral basilar system, which supplies blood to the posterior part of the circle of W ...
: Supplies the
midbrain
The midbrain or mesencephalon is the forward-most portion of the brainstem and is associated with vision, hearing, motor control, sleep and wakefulness, arousal (alertness), and temperature regulation. The name comes from the Greek ''mesos'', " ...
,
cerebellum
The cerebellum (Latin for "little brain") is a major feature of the hindbrain of all vertebrates. Although usually smaller than the cerebrum, in some animals such as the mormyrid fishes it may be as large as or even larger. In humans, the cerebel ...
, and usually branches into the
posterior cerebral artery
The posterior cerebral artery (PCA) is one of a pair of cerebral arteries that supply oxygenated blood to the occipital lobe, part of the back of the human brain. The two arteries originate from the distal end of the basilar artery, where it bifur ...
**
Anterior inferior cerebellar artery
The anterior inferior cerebellar artery (AICA) is one of three pairs of arteries that supplies blood to the cerebellum.
It arises from the basilar artery on each side at the level of the junction between the medulla oblongata and the pons in the ...
(AICA)
**
Pontine branches
The pontine arteries are a number of small arteries which come off at right angles from either side of the basilar artery and supply the pons and adjacent parts of the brain
A brain is an organ (biology), organ that serves as the center of the ...
**
Superior cerebellar artery
The superior cerebellar artery (SCA) is an artery of the head. It arises near the end of the basilar artery. It is a branch of the basilar artery. It supplies parts of the cerebellum, the midbrain, and other nearby structures. It is the cause of ...
(SCA)
*
Posterior cerebral artery
The posterior cerebral artery (PCA) is one of a pair of cerebral arteries that supply oxygenated blood to the occipital lobe, part of the back of the human brain. The two arteries originate from the distal end of the basilar artery, where it bifur ...
(PCA)
*
Posterior communicating artery
In human anatomy, the left and right posterior communicating arteries are arteries at the base of the brain that form part of the circle of Willis. Each posterior communicating artery connects the three cerebral arteries of the same side. Anterior ...
Venous drainage
The venous drainage of the cerebrum can be separated into two subdivisions: superficial and deep.
The superficial system is composed of
dural venous sinuses
The dural venous sinuses (also called dural sinuses, cerebral sinuses, or cranial sinuses) are venous channels found between the endosteal and meningeal layers of dura mater in the brain. They receive blood from the cerebral veins, receive cereb ...
, which have walls composed of dura mater as opposed to a traditional vein. The dural sinuses are therefore located on the surface of the cerebrum. The most prominent of these sinuses is the
superior sagittal sinus
The superior sagittal sinus (also known as the superior longitudinal sinus), within the human head, is an unpaired area along the attached margin of the falx cerebri. It allows blood to drain from the lateral aspects of anterior cerebral hemispher ...
which flows in the sagittal plane under the midline of the cerebral vault, posteriorly and inferiorly to the
confluence of sinuses
The confluence of sinuses (Latin: confluens sinuum), torcular Herophili, or torcula is the connecting point of the superior sagittal sinus, straight sinus, and occipital sinus. It is below the internal occipital protuberance of the skull. It dr ...
, where the superficial drainage joins with the sinus that primarily drains the deep venous system. From here, two
transverse sinuses
The transverse sinuses (left and right lateral sinuses), within the human head, are two areas beneath the brain which allow blood to drain from the back of the head. They run laterally in a groove along the interior surface of the occipital bone. ...
bifurcate and travel laterally and inferiorly in an S-shaped curve that forms the
sigmoid sinuses
The sigmoid sinuses (sigma- or s-shaped hollow curve), also known as the , are venous sinuses within the skull that receive blood from posterior dural venous sinus veins.
Structure
The sigmoid sinus is a dural venous sinus situated within the du ...
which go on to form the two
jugular vein
The jugular veins are veins that take deoxygenated blood from the head back to the heart via the superior vena cava. The internal jugular vein descends next to the internal carotid artery and continues posteriorly to the sternocleidomastoid ...
s. In the neck, the
jugular vein
The jugular veins are veins that take deoxygenated blood from the head back to the heart via the superior vena cava. The internal jugular vein descends next to the internal carotid artery and continues posteriorly to the sternocleidomastoid ...
s parallel the upward course of the
carotid arteries
In anatomy, the left and right common carotid arteries (carotids) (Entry "carotid"
in
superior vena cava
The superior vena cava (SVC) is the superior of the two venae cavae, the great venous trunks that return deoxygenated blood from the systemic circulation to the right atrium of the heart. It is a large-diameter (24 mm) short length vein th ...
.
The deep venous drainage is primarily composed of traditional veins inside the deep structures of the brain, which join behind the midbrain to form the
vein of Galen. This vein merges with the
inferior sagittal sinus
The inferior sagittal sinus (also known as inferior longitudinal sinus), within the human head, is an area beneath the brain which allows blood to drain outwards posteriorly from the center of the head. It drains (from the center of the brain) to ...
to form the
straight sinus which then joins the superficial venous system mentioned above at the
confluence of sinuses
The confluence of sinuses (Latin: confluens sinuum), torcular Herophili, or torcula is the connecting point of the superior sagittal sinus, straight sinus, and occipital sinus. It is below the internal occipital protuberance of the skull. It dr ...
.
Physiology
![Sobo 1909 589](https://upload.wikimedia.org/wikipedia/commons/0/0f/Sobo_1909_589.png)
Cerebral blood flow (CBF) is the blood supply to the
brain
A brain is an organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is located in the head, usually close to the sensory organs for senses such as vision. It is the most complex organ in a v ...
in a given period of time.
[Tolias C and Sgouros S. 2006]
"Initial Evaluation and Management of CNS Injury."
Emedicine.com. Accessed January 4, 2007. In an adult, CBF is typically 750 millilitres per minute or 15% of the
cardiac output
In cardiac physiology, cardiac output (CO), also known as heart output and often denoted by the symbols Q, \dot Q, or \dot Q_ , edited by Catherine E. Williamson, Phillip Bennett is the volumetric flow rate of the heart's pumping output: t ...
. This equates to an average
perfusion
Perfusion is the passage of fluid through the circulatory system or lymphatic system to an organ or a tissue, usually referring to the delivery of blood to a capillary bed in tissue. Perfusion is measured as the rate at which blood is deliver ...
of 50 to 54 millilitres of blood per 100 grams of brain tissue per minute.
[Orlando Regional Healthcare, Education and Development. 2004]
"Overview of Adult Traumatic Brain Injuries."
Accessed 2008-01-16.[Shepherd S. 2004]
Emedicine.com. Shepherd S. 2004
Emedicine.com. Accessed January 4, 2007.[Walters, FJM. 1998.]
Physiology. Issue 8, Article 4. Accessed January 4, 2007. CBF is tightly regulated to meet the brain's
metabolic
Metabolism (, from el, μεταβολή ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run cell ...
demands.
[Singh J and Stock A. 2006]
"Head Trauma."
Emedicine.com. Accessed January 4, 2007. Too much blood (a clinical condition of a normal homeostatic response of
hyperemia
Hyperaemia (also hyperemia) is the increase of blood flow to different tissues in the body. It can have medical implications but is also a regulatory response, allowing change in blood supply to different tissues through vasodilation. Clinically, ...
)
can raise
intracranial pressure
Intracranial pressure (ICP) is the pressure exerted by fluids such as cerebrospinal fluid (CSF) inside the skull and on the brain tissue. ICP is measured in millimeters of mercury (mmHg) and at rest, is normally 7–15 Millimeter of mercury, mmHg ...
(ICP), which can compress and damage delicate brain tissue. Too little blood flow (
ischemia
Ischemia or ischaemia is a restriction in blood supply to any tissue, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism (to keep tissue alive). Ischemia is generally caused by problems wi ...
) results if blood flow to the brain is below 18 to 20 ml per 100 g per minute, and tissue death occurs if flow dips below 8 to 10 ml per 100 g per minute. In brain tissue, a
biochemical cascade
A biochemical cascade, also known as a signaling cascade or signaling pathway, is a series of chemical reactions that occur within a biological cell when initiated by a stimulus. This stimulus, known as a first messenger, acts on a receptor that ...
known as the
ischemic cascade
The ischemic (ischaemic) cascade is a series of biochemical reactions that are initiated in the brain and other aerobic tissues after seconds to minutes of ischemia (inadequate blood supply). This is typically secondary to stroke, injury, or cardi ...
is triggered when the tissue becomes ischemic, potentially resulting in damage to and the death of
brain cells
Brain cells make up the functional tissue of the brain. The rest of the brain tissue is structural or connective called the stroma which includes blood vessels. The two main types of cells in the brain are neurons, also known as nerve cells, an ...
. Medical professionals must take steps to maintain proper CBF in patients who have conditions like
shock
Shock may refer to:
Common uses Collective noun
*Shock, a historic commercial term for a group of 60, see English numerals#Special names
* Stook, or shock of grain, stacked sheaves
Healthcare
* Shock (circulatory), circulatory medical emergen ...
,
stroke
A stroke is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both cause parts of the brain to stop functionin ...
,
cerebral edema
Cerebral edema is excess accumulation of fluid (edema) in the intracellular or extracellular spaces of the brain. This typically causes impaired nerve function, increased pressure within the skull, and can eventually lead to direct compressio ...
, and
traumatic brain injury
A traumatic brain injury (TBI), also known as an intracranial injury, is an injury to the brain caused by an external force. TBI can be classified based on severity (ranging from mild traumatic brain injury TBI/concussionto severe traumatic b ...
.
Cerebral blood flow is determined by a number of factors, such as
viscosity
The viscosity of a fluid is a measure of its resistance to deformation at a given rate. For liquids, it corresponds to the informal concept of "thickness": for example, syrup has a higher viscosity than water.
Viscosity quantifies the inte ...
of blood, how dilated
blood vessel
The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide away ...
s are, and the net pressure of the flow of blood into the brain, known as
cerebral perfusion pressure Cerebral perfusion pressure, or CPP, is the net pressure gradient causing cerebral blood flow to the brain (brain perfusion). It must be maintained within narrow limits because too little pressure could cause brain tissue to become ischemic (having ...
, which is determined by the body's
blood pressure
Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term "blood pressure" r ...
. Cerebral perfusion pressure (CPP) is defined as the mean arterial pressure (MAP) minus the intracranial pressure (ICP). In normal individuals, it should be above 50 mm Hg. Intracranial pressure should not be above 15 mm Hg (ICP of 20 mm Hg is considered as intracranial hypertension). Cerebral blood vessels are able to change the flow of blood through them by altering their diameters in a process called
cerebral autoregulation Cerebral autoregulation is a process in mammals, which aims to maintain adequate and stable cerebral blood flow. While most systems of the body show some degree of autoregulation, the brain is very sensitive to over- and underperfusion. Cerebral au ...
; they constrict when systemic blood pressure is raised and dilate when it is lowered.
[Kandel E.R., Schwartz, J.H., Jessell, T.M. 2000. Principles of Neural Science, 4th ed., McGraw-Hill, New York. p.1305] Arterioles also constrict and dilate in response to different chemical concentrations. For example, they dilate in response to higher levels of
carbon dioxide
Carbon dioxide (chemical formula ) is a chemical compound made up of molecules that each have one carbon atom covalently double bonded to two oxygen atoms. It is found in the gas state at room temperature. In the air, carbon dioxide is transpar ...
in the blood and constrict in response to lower levels of carbon dioxide.
For example, assuming a person with an arterial partial pressure of carbon dioxide (
PaCO2
''p''CO2, pCO2, or P_\ceis the partial pressure of carbon dioxide (CO2), often used in reference to blood but also used in meteorology, climate science, oceanography, and limnology to describe the fractional pressure of CO2 as a function of its c ...
) of 40 mmHg (normal range of 38–42 mmHg)
[Hadjiliadis D, Zieve D, Ogilvie I. Blood Gases. Medline Plus. 06/06/2015.](_blank)
/ref> and a CBF of 50 ml per 100g per min. If the PaCO2 dips to 30 mmHg, this represents a 10 mmHg decrease from the initial value of PaCO2. Consequently, the CBF decreases by 1ml per 100g per min for each 1mmHg decrease in PaCO2, resulting in a new CBF of 40ml per 100g of brain tissue per minute. In fact, for each 1 mmHg increase or decrease in PaCO2, between the range of 20–60 mmHg, there is a corresponding CBF change in the same direction of approximately 1–2 ml/100g/min, or 2–5% of the CBF value.[Giardino ND, Friedman SD, Dager SR. Anxiety, respiration, and cerebral blood flow: implications for functional brain imaging. Compr Psychiatry 2007;48:103–112. Accessed 6/6/2015.] This is why small alterations in respiration pattern can cause significant changes in global CBF, specially through PaCO2 variations.
CBF is equal to the cerebral perfusion pressure Cerebral perfusion pressure, or CPP, is the net pressure gradient causing cerebral blood flow to the brain (brain perfusion). It must be maintained within narrow limits because too little pressure could cause brain tissue to become ischemic (having ...
(CPP) divided by the cerebrovascular resistance (CVR):
:CBF = CPP / CVR
Control of CBF is considered in terms of the factors affecting CPP and the factors affecting CVR. CVR is controlled by four major mechanisms:
# Metabolic
Metabolism (, from el, μεταβολή ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run cell ...
control (or 'metabolic autoregulation')
# Pressure autoregulation
Autoregulation is a process within many biological systems, resulting from an internal adaptive mechanism that works to adjust (or mitigate) that system's response to stimuli. While most systems of the body show some degree of autoregulation, it ...
# Chemical control (by arterial pCO2 and pO2)
# Neural
In Biology, biology, the nervous system is the Complex system, highly complex part of an animal that coordinates its Behavior, actions and Sense, sensory information by transmitting action potential, signals to and from different parts of its ...
control
Role of intracranial pressure
Increased intracranial pressure
Intracranial pressure (ICP) is the pressure exerted by fluids such as cerebrospinal fluid (CSF) inside the skull and on the brain tissue. ICP is measured in millimeters of mercury (mmHg) and at rest, is normally 7–15 Millimeter of mercury, mmHg ...
(ICP) causes decreased blood perfusion of brain cell
Brain cells make up the functional tissue of the brain. The rest of the brain tissue is structural or connective called the stroma which includes blood vessels. The two main types of cells in the brain are neurons, also known as nerve cells, an ...
s by mainly two mechanisms:
* Increased ICP constitutes an increased interstitial hydrostatic pressure
The Starling equation describes the net Fluid dynamics, flow of fluid across a semipermeable membrane. It is named after Ernest Starling. It describes the balance between capillary pressure, interstitial pressure, and osmotic pressure. The classi ...
that, in turn, causes a decreased driving force for capillary filtration from intracerebral blood vessels.
* Increased ICP compresses cerebral arteries, causing increased cerebrovascular resistance (CVR).
Cerebral perfusion pressure
Cerebral perfusion pressure, or CPP, is the net pressure
Pressure (symbol: ''p'' or ''P'') is the force applied perpendicular to the surface of an object per unit area over which that force is distributed. Gauge pressure (also spelled ''gage'' pressure)The preferred spelling varies by country and e ...
gradient causing cerebral blood flow
Cerebral circulation is the movement of blood through a network of cerebral arteries and veins supplying the brain. The rate of cerebral blood flow in an adult human is typically 750 milliliters per minute, or about 15% of cardiac output. Arterie ...
to the brain (brain perfusion
Perfusion is the passage of fluid through the circulatory system or lymphatic system to an organ or a tissue, usually referring to the delivery of blood to a capillary bed in tissue. Perfusion is measured as the rate at which blood is deliver ...
). It must be maintained within narrow limits; too little pressure could cause brain tissue to become ischemic
Ischemia or ischaemia is a restriction in blood supply to any tissue, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism (to keep tissue alive). Ischemia is generally caused by problems w ...
(having inadequate blood flow), and too much could raise intracranial pressure
Intracranial pressure (ICP) is the pressure exerted by fluids such as cerebrospinal fluid (CSF) inside the skull and on the brain tissue. ICP is measured in millimeters of mercury (mmHg) and at rest, is normally 7–15 Millimeter of mercury, mmHg ...
(ICP).
Imaging
Arterial spin labeling Arterial spin labeling (ASL), also known as arterial spin tagging, is a magnetic resonance imaging technique used to quantify cerebral blood perfusion by labelling blood water as it flows throughout the brain. ASL specifically refers to magnetic lab ...
(ASL), phase contrast magnetic resonance imaging
Phase contrast magnetic resonance imaging (PC-MRI) is a specific type of magnetic resonance imaging used primarily to determine flow velocities. PC-MRI can be considered a method of Magnetic Resonance Velocimetry. It also provides a method of ma ...
(PC-MRI), and positron emission tomography
Positron emission tomography (PET) is a functional imaging technique that uses radioactive substances known as radiotracers to visualize and measure changes in Metabolism, metabolic processes, and in other physiological activities including bl ...
(PET) are neuroimaging
Neuroimaging is the use of quantitative (computational) techniques to study the structure and function of the central nervous system, developed as an objective way of scientifically studying the healthy human brain in a non-invasive manner. Incre ...
techniques that can be used to measure CBF. ASL and PET can also be used to measure regional CBF (rCBF) within a specific brain region.
rCBF at one location can be measured over time by thermal diffusion[P. Vajkoczy, H. Roth, P. Horn, T. Lucke, C. Thome, U. Hubner, G. T. Martin, C. Zappletal, E. Klar, L. Schilling, and P. Schmiedek, “Continuous monitoring of regional cerebral blood flow: experimental and clinical validation of a novel thermal diffusion microprobe,” J. Neurosurg., vol. 93, no. 2, pp. 265–274, Aug. 2000]
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References
External links
Computer Model of the Cerebral Circulation for Training and Education
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Neurology
Cardiology