Stroke, Vol 25, 1985-1988, Copyright © 1994 by American Heart Association
FS Larsen, KS Olsen, BA Hansen, OB Paulson and GM Knudsen
BACKGROUND AND PURPOSE: This study validates transcranial Doppler
sonography (TCD) for determination of the lower limit of cerebral blood
flow (CBF) autoregulation and establishes a relation between global CBF and
mean flow velocity (Vmean) in the middle cerebral artery. METHODS: Relative
changes in CBF and in Vmean were compared in 12 normal volunteers (2 women
and 10 men; median age, 30 years [range, 21 to 61 years]). Catheters was
placed in the left radial artery and in the bulb of the right internal
jugular vein, respectively. Baseline CBF was measured by single-photon
emission computed tomography scanning; concomitantly, blood samples were
drawn for calculation of the cerebral arteriovenous oxygen difference. Then
changes in mean arterial pressure (MAP) were induced, and relative changes
in global CBF were calculated according to Fick's principle assuming a
constant cerebral oxygen metabolism. MAP was increased 30 mm Hg by
norepinephrine infusion and was decreased by lower body negative pressure.
Vmean was measured in the right middle cerebral artery by a 2-MHz probe,
and blood samples were drawn at intervals of 5 mm Hg. RESULTS: MAP values
between 122 (range, 110 to 140) and 48 (range, 34 to 75) mm Hg were
measured. The lower limit of autoregulation (the blood pressure under which
autoregulation is off) as determined by Vmean did not differ significantly
from that determined by relative changes in global CBF: 91 (range, 41 to
108) and 79 (range, 53 to 113) mm Hg, respectively. A significant
correlation between Vmean and relative changes in global CBF was
demonstrated below the lower limit of autoregulation (R2 = .73, P <
.001; CBF = -6.3 + 1.0.Vmean). Above the lower limit both values were
stable. CONCLUSIONS: TCD is valid for determination of the lower limit of
CBF autoregulation, and changes in CBF may be reliably evaluated by TCD
during changes in cerebral perfusion pressure in normal subjects.
ARTICLES
Transcranial Doppler is valid for determination of the lower limit of cerebral blood flow autoregulation
Department of Medicine, Rigshospitalet, University of Copenhagen, Denmark.
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