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Cerebral Autoregulation

Monroe-Kelly Doctrine

The doctrine that the central nervous


system and its accompanying fluids are
enclosed in a rigid container whose total
volume tends to remain constant. An
increase in volume of one component
(e.g., brain, blood, or cerebrospinal fluid)
will elevate pressure and decrease the
volume of one of the other elements.
Terminology
• Cerebral Perfusion Pressure :
CPP = MAP - ICP
The pressure gradient acting across the cerebrovascular bed and, therefore,
a major factor in determining cerebral blood flow (CBF)
• Cerebral Blood Flow (CBF)
Blood supply to the brain in a given period of time
• Mean Arterial Pressure
Average arterial pressure during a single cardiac cycle
• Intracranial Pressure
The pressure inside the skull and thus in the brain and cerebrospinal fluid
Terminology

Morton R., Ellenbogen RG. 2005. Intracranial hypertension: Principle of Neurological Surgery, Third edition. USA. Elsevier Saunders. p. 311-23
Cerebral Blood Flow (CBF)
Blood supply to the brain in a given period of time

CBF of 50 mL/100 g/min : Normal


CBF of 25 mL/100 g/min : Electroencephalogram slowing
CBF of 15 mL/100 g/min : Isoelectric electroencephalogram
CBF of 6 to 15 mL/100 g/min : Ischemic penumbra
CBF of less than 6 mL/100 g/min : Neuronal death
Morton R., Ellenbogen RG. 2005. Intracranial hypertension: Principle of Neurological Surgery, Third edition. USA. Elsevier Saunders. p. 311-23
Cerebral Autoregulation
Autoregulation is a process of adjustment on the part of the
brain’s arterioles that keeps cerebrovascular resistance
constant over a range of CPP. Increased CPP causes stretching
of the walls of the arterioles, which compensate by dilating and
relieving this pressure. Likewise, in the setting of decreased
pressure, the arterioles constrict to maintain CPP. This
autoregulation prevents transient pressure increases from
being transmitted to smaller distal vessels. When the MAP is
less than 65 mm Hg or greater than 150 mm Hg, the arterioles
are unable to autoregulate, and blood flow becomes entirely
dependent on the blood pressure, a situation defined as
"pressure-passive flow." The CBF is no longer constant but is
dependent on and proportional to the CPP.
Factors Affecting Cerebral Vasculature

Morton R., Ellenbogen RG. 2005. Intracranial hypertension: Principle of Neurological Surgery, Third edition. USA. Elsevier Saunders. p. 311-23
Autoregulation Normal Condition
vs Pathological Condition

Morton R., Ellenbogen RG. 2005. Intracranial hypertension: Principle of Neurological Surgery, Third edition. USA. Elsevier Saunders. p. 311-23
Effect of hypercapnia on cerebral autoregulation

Hypercapnia affect the curve, the plateau ascends and shortens, the lower limit shift rightward, and the upper
limit leftward
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