Abstract
Critically reduced perfusion pressure in the brain arteries may lead to ischemic damage in certain vulnerable areas (Bogousslavsky and Regli 1986; Leblanc et al. 1987; Ringelstein et al. 1983; Yamaguchi et al. 1979; Zülch 1961). The perfusion pressure of the brain cannot, however, be measured directly in man. Indirect parameters are the regional cerebral blood flow (rCBF) versus regional cerebral blood volume (rCBV) ratio (Gibbs et al. 1984), or the oxygen extraction ratio (Gibbs et al. 1984; Kanno et al. 1988; Levine et al. 1988) documented either by SPECT or by PET imaging. Another approach is to measure the reactivity of the cerebral vasculature to vasodilating stimuli (CO2, acetazolamide). This may be done by measuring an increase in blood flow or blood flow velocity by either rCBF techniques or transcranial Doppler sonography (TCD) (Kanno et al. 1988; Norrving et al. 1982; Ringelstein et al. 1988; Wodarz 1980; see also Dahl et al. and Haberl et al. in this volume).
This project was in part supported by Verein zur Bekämpfung der Gefäßkrankheiten e.V., Engelskirchen.
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References
Aaslid R (1987) Visually evoked dynamic blood flow response of the human cerebral circulation. Stroke 18:771–775
Arnolds BJ, von Reutern GM (1986) Transcranial Doppler sonography. Examination technique and normal reference values. Ultrasound Med Biol 12:115–123
Bogousslavsky J, Regli F (1986) Unilateral watershed cerebral infarcts. Neurology 36:373–377
Breslau PJ, Knox R, Fell G, Greene FM, Thiele BL, Strandness BE Jr (1982) Effect of carbon dioxide on flow patterns in normal extracranial arteries. J Surg Res 32:97–103
Caplan LR, Sergay S (1976) Positional cerebral ischemia. J Neurol Neurosurg Psychiatry 39:385–391
Copetto JR, Wand M, Bear L, Sciarra R (1985) Neovascular glaucoma and carotid artery obstructive disease. Am J Ophthalmol 99:567–570
Gibbs JM, Wise RJS, Leenders KL, Jones T (1984) Evaluation of cerebral perfusion reserve in patients with carotid-artery occlusion. Lancet 1:310–314
Harper AM, Glass HI (1966) Effect of alteration in the arterial carbon dioxide tension on the blood flow to the cerebral cortex at normal and low arterial blood pressure. J Neurol Neurosurg Psychiatry 28:449–452
Kanno I, Uemura K, Higano S, Murakami M, Ieda H, Miura S, Shishido F, Inugami A, Sayama I (1988) Oxygen extraction fraction at maximally vasodilated tissue in the ischemic brain estimated from the regional C02-responsiveness measured by positron emission tomography. J Cereb Blood Flow Metab 8:227–235
Kety SS, Schmidt CF (1948) The effects of altered arterial tensions of carbon dioxide and oxygen on cerebral blood flow and cerebral oxygen consumption of normal young men. J Clin Invest 27:448–492
Keunen RWM, Ackerstaff RGA, Stegeman DF, Schulte, BPM (1989) The impact of internal carotid artery occlusion and of the integrity of the circle of Willis on cerebral vasomotor reactivity - a transcranial Doppler study. In: Meyer JS, et al. (eds) Cerebral vascular disease. Elsevier, Amsterdam, pp 85–88
Kindt GW, Humans JR, Convey LW (1969) The use of ultrasound to determine cerebral arterial reserve. J Neurösurg 31:544–549
Kirkham FJ, Padayachee TS, Parsons S, Seargeant LS, House RF, Gosling RG (1986) Transcranial measurement of blood flow velocities in the basal cerebral arteries using pulsed Doppler ultrasound: velocity as an index of flow. Ultrasound Med Biol 12:15–21
Leblanc R, Yamamoto YL, Tyler JL, Dikscic M, Hakim A (1987) Borderzone ischemia. Ann Neurol 22:707–713
Levine RL, Sunderland JJ, Lagreze HL, Niekies RJ, Rowe BR, Turski PA (1988) Cerebral perfusion reserve indexes determined by fluoromethane positron emission scanning. Stroke 19:19–27
Norrving B, Nilsson B, Risberg J (1982) rCBF in patients with carotid occlusion - resting and hypercapnic flow related to collateral pattern. Stroke 13:155–162
Ringelstein EB, Zeumer H, Angelou D (1983) The pathogenesis of strokes from internal carotid artery occlusion. Diagnostic and therapeutic implications. Stroke 14:867–875
Ringelstein EB, Sievers C, Ecker S, Schneider PA, Otis SM (1988) Non-invasive assessment of C02-induced cerebral vasomotor response in normal individuals and patients with internal carotid artery occlusions. Stroke 19:936–969
Ringelstein EB (1989) A practical guide to transcranial Doppler sonography. In: Weinberger J (ed) Non-invasive assessment of the cerebral circulation in cerebrovascular disease. Frontiers of clinical neuroscience theories. Liss, New York, pp 75–121
Ringelstein EB, Koschorke S, Holling A, Thron A, Lambertz H, Minale C (1989) Computerized tomography patterns of proven embolic brain infarctions. Ann Neurol 26:759–765
Ringelstein EB, Kahlscheuer B, Niggemeyer E, Otis SM (1990) Transcranial Doppler sonography: anatomical landmarks and normal velocity values. Ultrasound Med Biol 16:745–761
Ringelstein EB, van Eyck S, Mertens I (1991a) Evaluation of cerebral vasomotor reactivity by various vasodilating stimuli: comparison of C02 with acetazolamide. J Cereb Blood Flow Metab (in press)
Ringelstein EB, Weiller C, Weckesser M, Weckesser S (1991b) Cerebral vasomotor reactivity is significantly reduced in low-flow as compared to thromboembolic infarctions: the key role of the circle of Willis. J Neurol Sci (in press)
Ringelstein EB (1991) Physiologic testing of vasomotor reserve. In: Newell DW, Aaslid R (eds) Transcranial Doppler sonograpy. Clinical aspects. Raven, New York (in press)
Valk J (1980) Computed tomography and cerebral infarctions. Raven, New York
Weiller C, Ringelstein EB, Reiche W, Büll U (1991) Clinical and hemodynamical aspects of low-flow infarcts. Stroke 22:1117–1123
Widder B, Paulat K, Hackspacher J, Mayr E (1986) Transcranial Doppler C02-test for the detection of hemodynamically critical carotid artery stenosis and occlusions. Eur Arch Psychiatry Neurol Sci 236:162–168
Wodarz R (1980) Watershed infarctions and computed tomography: topographic study in cases with stenosis or occlusion of the carotid artery. Neuroradiology 19:245–248
Yamaguchi F, Meyer JS, Sakai F, Yamamoto M (1979) Normal human aging and cerebral vasoconstrictive responses to hypocapnia. J Neurol Sci 44:87–94
Yonas H, Gurr D, Latchav RE, Wolfson SD Jr (1987) Xenon computed tomographic blood flow mapping. In: Wood JH (ed) Cerebral blood flow. Physiologic and clinical aspects. McGraw- Hill, New York, pp 220–245
Young LH, Appen RE (1981) Ischemic oculopathy: a manifestation of carotid artery disease. Arch Neurol 38:358–361
Zülch KJ (1961) Die Pathogenese von Massenblutungen und Erweichungen unter besonderer Berücksichtigung klinischer Gesichtspunkte. Acta Neurochir [Suppl] (Wien) 7:51–117
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© 1992 Springer-Verlag, Berlin Heidelberg
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Ringelstein, E.B. (1992). Noninvasive Testing of Vasomotor Reserve. In: Schmiedek, P., Einhäupl, K., Kirsch, CM. (eds) Stimulated Cerebral Blood Flow. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-77102-6_17
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DOI: https://doi.org/10.1007/978-3-642-77102-6_17
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