NEUROPHYSIOLOGY OF
THE BRAIN
Dr Muh Ramli,
Department of Anesthesiology University of
Hasasnuddin
Makassar INDONESIA
OTAK MANUSIA
OTAK MANUSIA
Sebesar sayur kol
Seberat + 1 kg
Bisa ditadah dgn sebelah
tangan
1/50 Berat Badan
Normal brain
CEREBRAL VEINS
CT SCAN
Anterior cerebral
arteries
ACoA
Middle cerebral
artery
A1
Internal carotid
arteries
PCoA
P2
P1
basilar artery
Vertebral artery
NEUROPHYSILOGIS
C
BF
ICP
CMR O2
BBB
CEREBRAL BLOOD
Varies
FLOW
Physiology
CBF~50 mL/100g/m
Coupled to CMRO2{~3.5
mL/100g/m}
CBF = CPP/CVR
Autoregulated bet CPP 50-150
mmHg
REGULATION OF CBF
A.
B.
C.
50
60
120
160
200
MAP (mmHg)
125
PaCO2
75
PaO2
25
0
25
75
125
Partial pressure (mmHg)
175
Physiology
Physiology
Monroe-Kellie doctrine
Changes
Autoregulation
1. Myogenic mechanism
intrinsic response of smooth muscle cells in cerebral
arterioles to changes in MAP
2. Metabolic mechanism
Cerebral autoregulation
Physiology
Cerebral autoregulation
Extrinsic Mechanism
1. Respiratory Gas Tension
The most important is PaCO2
Acute
. Extrinsic Mechanism
2. Temperature
3. Viscosity
4. Autonomic Influences
CARBON DIOXIDE
Inhalation of 5% CO2
50% CBF
Inhalation of 7% CO2
100% CBF
Physiology
HT
SNS activity
Low pH causes vasodilatation
High pH causes vasoconstriction
Cerebral Metabolism
Neuronal
electrical
activity
Cellular
integrity
60%
40%
Normal brain oxygen requirement
CEREBRAL METABOLISM
Brain responsible for 20% of total body
oxygen consumption
Cerebral Metabolic Rate ( CMR ) usually
expressed in terms of Oxygen Consumption
( CMRO2 ) 3 3,8 ml/100gr/min
Brain is High Oxygen Consumption ,
Cerebral Metabolism
Glucose as primary energy source
Brain glucose consumption:
5 mg/100g/min over 90% metabolized
aerobically
CMRO2 parallels with glucose consumption
Acute hypoglycemia as devastating
hypoxia
Hyperglycemia accelerating cerebral
acidosis and cellular injury exacerbated
global hypoxic brain injury
BLOOD-BRAIN BARRIER
Continuous vs Fenestrate
Capillary
Continuous capillary
Specialized continuous capillary
throughout most CNS bound
together by tight junction
Cytoplasmic extension of
astrocyte end in expanded feet
wrap around capillaries
Fenestrate capillary
Are capillaries that contain
windows , or pores, that span
the endotelial lining, permits
rapid exchange of water and
large solute
BLOOD-BRAIN BARRIER
BLOOD-BRAIN BARRIER
Blood-brain
by
Severe hypertension
Tumors
Trauma
Strokes
Infection
Marked hypercapnia
Hypoxia
Seizure activity
Cerebrospinal Fluid
Cerebrospinal Fluid
Dynamic
Major function to protect CNS against
trauma
Found in cerebral ventricles and cisterns
and subarachnoid spaces
Formed by choroid plexuses of the
cerebral ventricles ( mainly lateral )
CSF production about 21 ml/hr ( 500
ml/day ) but total CSF volume about 150
ml