Cerebral Blood Flow Regulation and The Blood Brain Barrier Flashcards

1
Q

What are the proportions of blood flow to the brain

A
High 
55ml/100g tissue/min
15% of CO
2% of body weight 
20% oxygen consumption
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2
Q

What happens when blood flow to the brain is reduced by more than 50%

A

Insufficient oxygen delivery

Function becomes significantly impaired

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3
Q

What happens when CBF is interrupted

A

4 seconds - unconsciousness

minutes - irreversible brain damage

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4
Q

Define syncope

A

Fainting

Manifestation of reduced blood supply to the brain

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5
Q

What can cause syncope

A
Low blood pressure
Postural changes
Vaso-vagal attack 
Sudden pain
Emotional shock
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6
Q

Why is the glucose supply to the brain vital

A

The brain cannot store, synthesise or utilise any other sources of energy (though in starvation ketones can be used)

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7
Q

What occurs in hypoglycaemia

A

Disorientation, slurred speech, impaired motor function

Dangerous below 2mM

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8
Q

What is CBF regulated by

A

Mechanisms affecting total cerebral blood flow

Mechanisms which relate activity to the requirement in specific brain regions by altered localised blood flow

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9
Q

What is the range of auto regulation for total CBF

A

between mean arterial blood pressures (MABP) of 60 and 160mmHg

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10
Q

What occurs when the CBF is above the auto regulatory pressure range

A

Swelling of the brain in the cranium causes an increase in intracranial pressure

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11
Q

What is the mechanism for changing total cerebral blood flow autoregulation

A

Arteries and arterioles dilate or contract to maintain blood flow
Stretch-sensitive cerebral vascular smooth muscle contracts at high BP and vice versa

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12
Q

What is local autoregulation

A

Local brain activity determines the local O2 and glucose demands

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13
Q

What are the 2 mechanisms of local regulation of CBF

A

Neural and chemical

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14
Q

Describe the pattern of vascularisation in the CNS tissues

A

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

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15
Q

What are neural factors that regulate CBF

A

Sympathetic nerve stimualtion (main cerebral arteries) - vasoconstriction
Parasympathetic (facial) stimulation - vasodilation
Central cortical neurones - vasoconstriction on catecholamine release (A/NA)
Dopaminergic neurones - vasoconstriction

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16
Q

What is the significance of dopaminergic neurones on CBF regulation

A

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

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17
Q

What are the chemical factors that regulate CBF

A
CO2
pH
NO
K+
Adenosine 
Anoxia 
Kinins, prostaglandins, histamine, endothelins
All vasodilate
18
Q

What is the effect of CO2 on CBF

A

As CO2 increases CBF increases (sigmoid)

19
Q

Explain how CO2 affects CBF

A
  1. CO2 from blood or local metabolic activity generates H+ using carbonic anhydrase, as it cannot cross the BBB from the blood
  2. low pH causes relaxation of the contractile smooth muscle
  3. Vessels dilate
  4. Increased blood flow
20
Q

How are local changes to CBF measured

A

Equates to increased neuronal activity

Imaged via PET scanning and functional MRI

21
Q

Where is CBF produced

A

Ependymal cells in the ventricles, aqueducts and canals that are modified to form the choroid plexus

22
Q

Describe the circulation of CSF

A
  1. Lateral ventricles
    Cereberal hemispheres
  2. 3rd ventricle (via inter ventricular foramina)
    Diencephalon
  3. Cerebral aqueduct
    Midbrain
  4. 4th ventricle
    Pons and medulla
  5. Subarachnoid space (via medial and lateral apertures)
23
Q

What volume of CSF flows at one time

24
Q

What volume of CSF is produced each day and where

25
What are the functions of CSF
Shock absorbing – protection from trauma Removes waste products from cellular metabolism Supplies neurones with nutrients (secondary to blood) Contains immune cells
26
What is the clinical relevance of CSF not having protein
If protein is presence may be damage or a bacterial infection
27
Describe the junctions of the blood brain barrier
Extensive tight junctions at the endothelial cell-cell contacts Reduces solute and fluid leak across the capillary wall Capillaries of the CNS parenchyma from the pial cells gain BBB properties the deeper they are
28
Describe inter endothelial junctions of peripheral capillaries and BBB capillaries
BBB has much fewer tight junctions
29
What are some difference between peripheral and BBB capillaries
Peripheral vessels have sparse pericyte coverage, BBB has a dense coverage BBB are covered with end feet from astrocytes
30
Which substances are unable to cross the BBB but can cross the peripheral capillaries
Glucose, amino acids, many antibiotics, some toxins
31
How does the BBB control exchange of substances
Specific membrane transporters (influx and efflux transporters)
32
Where in the brain do blood-borne infectious agents mostly affect
The meninges as their vessels are not BBB, which reduces entry
33
Give examples of hydrophilic substances that enter the CSF and how they do so
Water - AQP1, AQP4 Glucose - GLUT1 Amino acids - 3 transporters electrolytes - transporter systems
34
Give examples of lipophilic substances that enter the CSF and how they do so
Oxygen, CO2, alcohol, anaesthetics | diffuse passively across the barrier down concentration gradient
35
What are circumventricular organs
Capillaries that lack BBB properties Found close to ventricles Generally involved in secreting into the circulation
36
What are the features of circumventricular organs
Capillaries are fenestrated and leaky Ventricular ependymal lining close to these areas are much tighter, limiting the exchange between them and CSF Requires access to the blood
37
Give and example of how circumventircular organs use blood
Posterior pituitary and median eminence secrete hormones The area postrema samples the plasma for toxins, inducing vomiting Others are involved in sensing electrolytes and regulates water intake
38
What is the clinical importance of the BBB
``` Breaks down in many pathological states Inflammation Infection Trauma Stroke ```
39
Explain how antihistamines affect the brain
H1 blockers are hydrophobic and therefore can passively diffuse across the BBB Histamine usually aids wakefulness and alertness so antihistamines make people drowsy
40
How does the BBB affect Parkinsons disease treatment
Key treatment involves increasing dopamine levels but dopamine cannot cross the BBB L-DOPA crosses the BBB via amino acid transporter and is converted to dopamine in the brain However, a lot of L-dopa is converted outside the brain and is therefore administrated with carpidopa to inhibit