Cerebral Blood Flow Regulation and The Blood Brain Barrier Flashcards
What are the proportions of blood flow to the brain
High 55ml/100g tissue/min 15% of CO 2% of body weight 20% oxygen consumption
What happens when blood flow to the brain is reduced by more than 50%
Insufficient oxygen delivery
Function becomes significantly impaired
What happens when CBF is interrupted
4 seconds - unconsciousness
minutes - irreversible brain damage
Define syncope
Fainting
Manifestation of reduced blood supply to the brain
What can cause syncope
Low blood pressure Postural changes Vaso-vagal attack Sudden pain Emotional shock
Why is the glucose supply to the brain vital
The brain cannot store, synthesise or utilise any other sources of energy (though in starvation ketones can be used)
What occurs in hypoglycaemia
Disorientation, slurred speech, impaired motor function
Dangerous below 2mM
What is CBF regulated by
Mechanisms affecting total cerebral blood flow
Mechanisms which relate activity to the requirement in specific brain regions by altered localised blood flow
What is the range of auto regulation for total CBF
between mean arterial blood pressures (MABP) of 60 and 160mmHg
What occurs when the CBF is above the auto regulatory pressure range
Swelling of the brain in the cranium causes an increase in intracranial pressure
What is the mechanism for changing total cerebral blood flow autoregulation
Arteries and arterioles dilate or contract to maintain blood flow
Stretch-sensitive cerebral vascular smooth muscle contracts at high BP and vice versa
What is local autoregulation
Local brain activity determines the local O2 and glucose demands
What are the 2 mechanisms of local regulation of CBF
Neural and chemical
Describe the pattern of vascularisation in the CNS tissues
Arteries enter the CNS tissue as branches of surface pial vessels (Pia mater)
These penetrate the brain parenchyma to form capillaries
These drain into venues and veins -> surface pial veins
What are neural factors that regulate CBF
Sympathetic nerve stimualtion (main cerebral arteries) - vasoconstriction
Parasympathetic (facial) stimulation - vasodilation
Central cortical neurones - vasoconstriction on catecholamine release (A/NA)
Dopaminergic neurones - vasoconstriction
What is the significance of dopaminergic neurones on CBF regulation
Innervate penetrating arterioles and pericytes around capillaries
Participate in the diversion of CB to high activity areas
Dopamine may cause contraction of pericytes via aminergic and serotoninergic receptors
What are the chemical factors that regulate CBF
CO2 pH NO K+ Adenosine Anoxia Kinins, prostaglandins, histamine, endothelins All vasodilate
What is the effect of CO2 on CBF
As CO2 increases CBF increases (sigmoid)
Explain how CO2 affects CBF
- CO2 from blood or local metabolic activity generates H+ using carbonic anhydrase, as it cannot cross the BBB from the blood
- low pH causes relaxation of the contractile smooth muscle
- Vessels dilate
- Increased blood flow
How are local changes to CBF measured
Equates to increased neuronal activity
Imaged via PET scanning and functional MRI
Where is CBF produced
Ependymal cells in the ventricles, aqueducts and canals that are modified to form the choroid plexus
Describe the circulation of CSF
- Lateral ventricles
Cereberal hemispheres - 3rd ventricle (via inter ventricular foramina)
Diencephalon - Cerebral aqueduct
Midbrain - 4th ventricle
Pons and medulla - Subarachnoid space (via medial and lateral apertures)
What volume of CSF flows at one time
80-150ml
What volume of CSF is produced each day and where
500ml