From the Departments of Neurosurgery (T.N., S.W., Y.M., K.H.) and
Neurology (T.Y.), School of Medicine, Tokyo Medical and Dental University, and
the Positron Medical Center, Tokyo Metropolitan Institute of Gerontology
(T.N., M.S., K.I., H.T.), Tokyo, Japan.
Background and Purpose—The
alteration of regional cerebral blood flow (CBF) during and after
hyperventilation was measured using positron emission tomography (PET)
to determine the circulatory response induced by daily respiratory
changes in the cerebral area under chronic hemodynamic stress.
Methods—Three normal volunteers and 12 patients with an
obstruction of major cerebral arteries underwent PET measurements of
the CBF after an injection of H215O: (1) in the
resting condition, (2) during hyperventilation (HV scan), (3) 1 to 3
minutes after hyperventilation (post-HV scan), (4) during the
inhalation of 5% CO2, and (5) after an injection of
acetazolamide. Eleven patients also underwent a
15O gas study to measure CBF, oxygen extraction fraction
(OEF), and cerebral blood volume (CBV).
Results—(1) In 9 patients, the CBF value in the post-HV scan was
lower than that in the HV scan in 1 or more regions in the area of the
obstructed arteries, although the PaCO2 level
during the post-HV scan was higher than that during the HV scan in all
patients. All control regions in the patients and in the normal
volunteers showed an elevated CBF in the post-HV scan compared with the
HV scan. (2) The negative post-HV response (posthyperventilatory steal)
was prominent in 4 patients with moyamoya vessels and in another 5
patients with atherosclerotic disease who had PET evidence of
hemodynamic stress (elevated CBV or OEF). (3) The
regional pre- to post-HV change in CBF was significantly correlated
with the CBF responses to acetazolamide and
CO2.
Conclusions—Vasodilatation after the termination of
hyperventilation in the normal areas induces a steal response in the
cerebral area suffering from hemodynamic stress and may
cause profound hypoperfusion in everyday situations. This phenomenon
may be important to our understanding of the clinical symptoms and the
natural course of chronic cerebral occlusive disease bearing
hemodynamic stress.
© 1998 American Heart Association, Inc.
Original Contributions
Posthyperventilatory Steal Response in Chronic Cerebral Hemodynamic Stress
A Positron Emission Tomography Study
Key Words: tomography, emission computed • cerebral blood flow • hyperventilation • acetazolamide • carbon dioxide • moyamoya disease
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