Quantification of Dynamic Cerebral Autoregulation: Welcome to the Jungle!

Overview

Journal Clin Auton Res

Date 2023 Sep 27

PMID 37758907

Authors

Patrice Brassard

Marc-Antoine Roy

Joel S Burma

Lawrence Labrecque

Jonathan D Smirl

Affiliations

Soon will be listed here.

Abstract

Purpose: Patients with dysautonomia often experience symptoms such as dizziness, syncope, blurred vision and brain fog. Dynamic cerebral autoregulation, or the ability of the cerebrovasculature to react to transient changes in arterial blood pressure, could be associated with these symptoms.

Methods: In this narrative review, we go beyond the classical view of cerebral autoregulation to discuss dynamic cerebral autoregulation, focusing on recent advances pitfalls and future directions.

Results: Following some historical background, this narrative review provides a brief overview of the concept of cerebral autoregulation, with a focus on the quantification of dynamic cerebral autoregulation. We then discuss the main protocols and analytical approaches to assess dynamic cerebral autoregulation, including recent advances and important issues which need to be tackled.

Conclusion: The researcher or clinician new to this field needs an adequate comprehension of the toolbox they have to adequately assess, and interpret, the complex relationship between arterial blood pressure and cerebral blood flow in healthy individuals and clinical populations, including patients with autonomic disorders.

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References

Goldstein D, Robertson D, Esler M, Straus S, Eisenhofer G . Dysautonomias: clinical disorders of the autonomic nervous system. Ann Intern Med. 2002; 137(9):753-63. DOI: 10.7326/0003-4819-137-9-200211050-00011. View

McWhirter L, Smyth H, Hoeritzauer I, Couturier A, Stone J, Carson A . What is brain fog?. J Neurol Neurosurg Psychiatry. 2023; 94(4):321-325. DOI: 10.1136/jnnp-2022-329683. View

Ocon A, Medow M, Taneja I, Clarke D, Stewart J . Decreased upright cerebral blood flow and cerebral autoregulation in normocapnic postural tachycardia syndrome. Am J Physiol Heart Circ Physiol. 2009; 297(2):H664-73. PMC: 2724195. DOI: 10.1152/ajpheart.00138.2009. View

Castro P, Santos R, Freitas J, Panerai R, Azevedo E . Autonomic dysfunction affects dynamic cerebral autoregulation during Valsalva maneuver: comparison between healthy and autonomic dysfunction subjects. J Appl Physiol (1985). 2014; 117(3):205-13. DOI: 10.1152/japplphysiol.00893.2013. View

Schondorf R, Benoit J, Stein R . Cerebral autoregulation is preserved in postural tachycardia syndrome. J Appl Physiol (1985). 2005; 99(3):828-35. DOI: 10.1152/japplphysiol.00225.2005. View

Pavy-Le Traon A, Hughson R, Thalamas C, Galitsky M, Fabre N, Rascol O . Cerebral autoregulation is preserved in multiple system atrophy: A transcranial Doppler study. Mov Disord. 2006; 21(12):2122-6. DOI: 10.1002/mds.21130. View

Lassen N . Cerebral blood flow and oxygen consumption in man. Physiol Rev. 1959; 39(2):183-238. DOI: 10.1152/physrev.1959.39.2.183. View

Paulson O, Strandgaard S, Edvinsson L . Cerebral autoregulation. Cerebrovasc Brain Metab Rev. 1990; 2(2):161-92. View

Brassard P, Labrecque L, Smirl J, Tymko M, Caldwell H, Hoiland R . Losing the dogmatic view of cerebral autoregulation. Physiol Rep. 2021; 9(15):e14982. PMC: 8319534. DOI: 10.14814/phy2.14982. View

10.

Schondorf R, Stein R, Roberts R, Benoit J, Cupples W . Dynamic cerebral autoregulation is preserved in neurally mediated syncope. J Appl Physiol (1985). 2001; 91(6):2493-502. DOI: 10.1152/jappl.2001.91.6.2493. View

11.

VAN DER Scheer J, Kamijo Y, Leicht C, Millar P, Shibasaki M, Goosey-Tolfrey V . A comparison of static and dynamic cerebral autoregulation during mild whole-body cold stress in individuals with and without cervical spinal cord injury: a pilot study. Spinal Cord. 2018; 56(5):469-477. DOI: 10.1038/s41393-017-0021-7. View

12.

Sahota I, Lucci V, McGrath M, Ravensbergen H, Claydon V . Cardiovascular and cerebrovascular responses to urodynamics testing after spinal cord injury: The influence of autonomic injury. Front Physiol. 2022; 13:977772. PMC: 9525190. DOI: 10.3389/fphys.2022.977772. View

13.

Saleem S, Vucina D, Sarafis Z, Lee A, Squair J, Barak O . Wavelet decomposition analysis is a clinically relevant strategy to evaluate cerebrovascular buffering of blood pressure after spinal cord injury. Am J Physiol Heart Circ Physiol. 2018; 314(5):H1108-H1114. PMC: 6008151. DOI: 10.1152/ajpheart.00152.2017. View

14.

Wilson L, Cotter J, Fan J, Lucas R, Thomas K, Ainslie P . Cerebrovascular reactivity and dynamic autoregulation in tetraplegia. Am J Physiol Regul Integr Comp Physiol. 2010; 298(4):R1035-42. DOI: 10.1152/ajpregu.00815.2009. View

15.

Castro P, Freitas J, Azevedo E, Tan C . Cerebrovascular regulation in patients with vasovagal syncope and autonomic failure due to familial amyloidotic polyneuropathy. Auton Neurosci. 2022; 242:103010. DOI: 10.1016/j.autneu.2022.103010. View

16.

Carey B, Manktelow B, Panerai R, Potter J . Cerebral autoregulatory responses to head-up tilt in normal subjects and patients with recurrent vasovagal syncope. Circulation. 2001; 104(8):898-902. DOI: 10.1161/hc3301.094908. View

17.

Bayliss W, Hill L, Gulland G . On Intra-Cranial Pressure and the Cerebral Circulation: Part I. Physiological; Part II. Histological. J Physiol. 1895; 18(4):334-62. PMC: 1514585. DOI: 10.1113/jphysiol.1895.sp000572. View

18.

Fog M . THE RELATIONSHIP BETWEEN THE BLOOD PRESSURE AND THE TONIC REGULATION OF THE PIAL ARTERIES. J Neurol Psychiatry. 2011; 1(3):187-97. PMC: 1088094. DOI: 10.1136/jnnp.1.3.187. View

19.

Dagal A, Lam A . Cerebral autoregulation and anesthesia. Curr Opin Anaesthesiol. 2009; 22(5):547-52. DOI: 10.1097/ACO.0b013e32833020be. View

20.

Faraci F, Heistad D, Mayhan W . Role of large arteries in regulation of blood flow to brain stem in cats. J Physiol. 1987; 387:115-23. PMC: 1192497. DOI: 10.1113/jphysiol.1987.sp016566. View