Week 13 Flashcards
There are 5 main components to the Circle of Willis:
- anterior cerebral artery
- anterior communicating artery
- internal carotid arteries
- posterior cerebral artery
- posterior communicating artery
The circle of willis is…
a junction of several important arteries at the bottom part of the brain.
Originally cerebral BF was measured using inert ____
tracers
- Method is based on Fick principle: arterio-venous difference of tracer is proportional to volume of blood flow through brain
Limitations of tracers
- Poor temporal resolution
- Only global measure of blood flow
- Arterial lines necessary
- Value of cerebral oxygenation must be assumed
- Venous outflow from brain may not be symmetrical
How is blood flow measured now?
Transcranial Doppler (TCD): Tool for examining cerebrovascular function (relatively low-cost, easy to use, non-invasive, high temporal resolution).
Insonation is possible through thinner regions of the skull, termed “_____” windows, making it feasible to measure static and dynamic blood velocities within the major cerebral arteries through the transcranial doppler (TCD)
acoustic
The transcranial doppler (TCD) measures cerebral blood flow _____
velocity
Key regulators of cerebral blood flow include:
- cerebral metabolism (neurovascular coupling)
- partial pressure of arterial Co2 (cerebrovascular reactivity)
- Mean arterial pressure (cerebral autoregulation)
Cerebral BF regulator: Cerebral metabolism (neurovascular coupling) …
Neuromuscular coupling can be demonstrated when measuring posterior cerebral artery velocity during activities such as reading
- higher the activity, more blood flow required, brain adapts to it
Cerebral BF regulator: Partial pressure of arterial Co2 (cerebrovascular reactivity)
Co2 increases cerebral blood flow (and Co2 decrease, decreases BF to brain)
Decrease in PaCo2 (hypoxia) causes cerebral vasodilation leading to increase in ____ (i.e. opposite effect of CO2)
cerebral BF
However, hypoxia leads to hyperventilation (when there is not enough O2 and we try to breathe to quickly and too deeply), which causes hypocapnia (fall in Co2), leading to ______ cerebral blood flow
decreased
Cerebral BF regulator: Mean arterial pressure (cerebral autoregulation)
Dynamic cerebral autoregulation = ability of cerebrovasculature to resist acute changes in perfusion pressure (due to changes in BP) over a short time course of less than 5 seconds
Assessment of cerebral autoregulation:
- Transfer function analysis
- Postural alterations
- Valsalva manoeuvre
- The Oxford technique
- Suprasystolic thigh cuffs
Changes in BP used to assess response of cerebral BF (cerebral autoregulation)
Thigh cuff deflation:
- Thigh cuffs are inflated to suprasystolic (above systolic) pressures for >2min
- Rapid deflation of cuffs causes transient hypotension
- Rate at which cerebrovascular resistance changes in response to BP is measured