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This e-book will review special features of the cerebral circulation and how they contribute to the physiology of the brain. It describes structural and functional properties of the cerebral circulation that are unique to the brain, an organ with high metabolic demands and the need for tight water and ion homeostasis. Autoregulation is pronounced in the brain, with myogenic, metabolic and neurogenic mechanisms contributing to maintain relatively constant blood flow during both increases and decreases in pressure. In addition, unlike peripheral organs where the majority of vascular resistance resides in small arteries and arterioles, large extracranial and intracranial arteries contribute significantly to vascular resistance in the brain. The prominent role of large arteries in cerebrovascular resistance helps maintain blood flow and protect downstream vessels during changes in perfusion pressure. The cerebral endothelium is also unique in that its barrier properties are in some way more like epithelium than endothelium in the periphery. The cerebral endothelium, known as the blood-brain barrier, has specialized tight junctions that do not allow ions to pass freely and has very low hydraulic conductivity and transcellular transport. This special configuration modifies Starling's forces in the brain microcirculation such that ions retained in the vascular lumen oppose water movement due to hydrostatic pressure. Tight water regulation is necessary in the brain because it has limited capacity for expansion within the skull. Increased intracranial pressure due to vasogenic edema can cause severe neurologic complications and death.
Cerebral Blood Flow: Quantifying Consciousness Although the heart may be the source of energy needed to generate blood flow,and other organs absolutely essential for normal living,the brain is the reason we are alive. The collected book chapters are aimed at addressing this most fundamental organ and its blood flow. These papers reflect detailed descriptions of similar topics presented over a two-day period as part of the 5th International Symposium on Applied Physiology of the Peripheral Circulation held in Pittsburgh, Pennsylvania, in June 2000. The symposium and this volume were organized into four distinct groupings that follow in a logical fashion. The initial papers focus on the basic unique physiology and pathophysiology of the cerebral circulation, including a historical reviewof the means to measure cerebral blood flow and its implications of the past 30 years. Dr. Walter D. Obrist was one of the original investigators to use radiolabeled markers to assess cerebral blood flow. His equations and initial studies form an impressive introduction to where we are now. As with much of the body's special organs, the brain too has many circulatory features unique to itself.These include the unique blood-brain barrier function ofthe endothelium, local neural regulation control, and intracranial pressure effects. These special issues,plus genetic factors that may predispose individuals to developing cere bral aneurysm, make up the initial section of the monograph.
Because stroke is essentially a disease of the vessels and blood flow, the most fundamental aspects of ischemic blood flow in the brain are under investigation by researchers. Their work was the focus of the sixth in the series of Keio University International Symposia for Life Sciences and Medicine, held in Tokyo in 1999. Selected here are 55 papers from the symposium, covering the buffy coat (glycocalyx) of endothelial cells, the blood-brain barrier and permeability, gene expression, vascular reactivity, dysregulation, inflammatory deterioration, cortical spreading depression, edema, microvascular derangement, and pathology, in ten major sections. The book includes the thought-provoking discussions that followed the presentations, thus providing an invaluable source of up-to-date information not only for researchers investigating microcirculation but also for clinicians implementing the most effective treatment for stroke patients.
Professor Caplan has extensively edited the book to shape and organize the contents into a succinct presentation by experts of the basic science and clinical aspects of the topic. The text has been divided into sections: The Brain.- Macroscopic and microscopic molecular aspects of brain ischemia, including pathophysiology, pathology, biochemistry, and clinical measurement.- Blood Vessels.- Their constitution and the pathology and physiology of the endothelium and arterial wall.- Blood Flow.- Its physics, control, rheology, and pathophysiology.- Blood.- The role of the cellular and serological constituents in coagulation and fibrinolysis. - Heart.- Sources of embolism and cardiac changes caused by brain ischemia.- And Epidemiology, Databases, and Trials. Prefatory remarks by Professor Caplan introduce each section. At the end of each section he relates the basic concepts to patient problems in the clinic, integrates the various contributions in the section, and covers other areas not discussed by the individual contributors.
In this volume, one of a series of monographs devoted to the problems of cerebral ischemia and related topics, we present the proceedings of an international conference on Cerebral Ischemia and Basic Mechanisms held in Bad Schachen/Lake Constance, Germany in June 1992. The enormous progress in research recently on the basic mechanisms associated with cerebral ischemia has provided greater insight into the pathophysiological mechanisms of reduced brain perfusion and decreased cerebral metabolism. The high technology instrumentation used to unravel the intricacies of cerebral blood flow and metabolism includes positron emission tomography and magnetic resonance imaging. A description of sophisticated neurophysiological techniques will give the reader insight into new models of reversible and irreversible tissue damage and changes at the molecular level have been described. The therapeutic approaches which have developed from this re search have been or will be used in clinical trials and will open new avenues in the treatment of stroke. The organizers of the meeting would like to thank the advisory board for its helpful suggestions and the Deutsche Forschungsgemeinschaft and other sponsors for their important support.
Das vorliegende Buch enth{lt die Beitr{ge eines internatio- nalen Symposiumszum Thema "Stimulierte Hirndurchblutung". Vorgestellt werden zun{chst neue Erkenntnisse zur Regulation der Hinrdurchblutung. Im 2. Abschnitt kommen verschiedene Methoden zur Messung der Hirndurchblutung zur Sprache, die sowohl unter experimentellen als auch unter klinischen Be- dingungengetestet wurden. Es folgt ein Abschnitt, der ver- schiedene M|glichkeiten zur Stimulation der Hirndurchblutung aufzeigt. Im letzten Abschnitt wird aufdie Bedeutung der stimulierten Hirndurchblutungsmessung zur Bestimmung der ce- rebrovascul{ren Reservekapazit{ten hingewiesen. Dieser Para- meter hat nach den vorliegenden Untersuchungen klinisch- praktische Bedeutung, beispielsweise f}r die Indikations- stellung bei cerebrovascul{ren Eingriffen zur Isch{mie-Pro- phylaxe.
This book contains the scientific contributions presented during the inter national symposium "Cerebral Ischemia and Hemorheology", held in Germany in June 1987. The purpose of the symposium was to bring together experts in the fields of cerebral circulation and rheology, in order to increase the knowl edge and scope of both of these groups by making the members of each group more aware of work in the complementary field. The organizers hoped to stimulate the discussion between both groups and to reach adecision about whether the alteration of rheologie parameters might change the course and fate of cerebral ischemia. The contributions also report on clinical and basic studies pertinent to the topic of the symposium. The book is a comprehensive description of the state of the art wich may help to define what is known and to find new strategies to better und erstand metabolie, circulatory, and rheologie changes during cerebral ischemia. The selection of papers for publication was the task of the advisory board. The editors would like to thank the members for their critical analyses and suggestions; they are: Shu Chien, New York; F. Gotoh, Tokio; K.A. Hossmann, Cologne; G. Schmid-Schönbein, Aachen; L. Symon, London; and F. Yatsu, Houston. Bonn ALEXANDER HARTMANN WOLFGANG KUSCHINSKY Contents Local Control ofthe Cerebral Circulation. W. KUSCHINSKY (With 2 Figures) . . . . . . . . . . . . . . . . . .
Magnetic Resonance Neuroimaging is a comprehensive volume that focuses on the newest fields of MRI from functional and metabolic mapping to the latest applications of neuro-interventional techniques. Each chapter offers critical discussions regarding available methods and the most recent advances in neuroimaging, including such topics as the use of diffusion and perfusion MRI in the early detection of stroke, the revolutionary advent of high-speed MRI for non-invasively mapping cortical responses to task activation paradigms, and the principles and applications of contrast agents. The chapters also discuss how these new advances are applied to problems in patients ranging in age from the newborn to the elderly, as well as disease states ranging from metabolic encephalopathy to cardiovascular disorders and stroke. Magnetic Resonance Neuroimaging will be a valuable text/reference for residents, research fellows, and clinicians in radiology, neuroradiology, and magnetic resonance imaging.