SummaryCerebral blood flow was studied by the arteriovenous oxygen difference method in patients with severe hypertension and in normotensive controls. The blood pressure was lowered to study the lower limit of autoregulation (the pressure below which cerebral blood flow decreases) and the pressure limit of brain hypoxia. Both limits were shifted upwards in the hypertensive patients, probably as a consequence of hypertrophy of the arteriolar walls. These findings have practical implications for antihypertensive therapy.When the blood pressure was raised some patients showed an upper limit of autoregulation beyond which an increase of cerebral blood flow above the resting value was seen without clinical symptoms. No evidence of vasospasm was found in any patient at high blood pressure. These observations may be of importance for the understanding of the pathogenesis of hypertensive encephalopathy.
1. This paper reports regional cerebral blood flow (rCBF) measurements in 254 cortical regions with 133Xe injected into the internal carotid artery in 19 patients, none of whom had any major neurological defect. The purpose was to demonstrate the pattern of cortical activity, as revealed by rCBF increases, during two types of unilateral voluntary movement in extrapersonal space: a) the maze test, series of fast isolated movements in various directions in a frame, executed under verbal command; and b) the drawing of a spiral in the air. 2. Both types of movements were associated with increases of rCBF in the supplementary motor area (bilaterally), the convexity part of the premotor area (bilaterally), the primary sensorimotor hand and arm area (contralaterally), and in the superior and inferior parietal region (bilaterally). 3. During the maze test there were, in addition, bilateral focal increases of the blood flow in the auditory areas, the inferior frontal regions, and the frontal eye fields. 4. It is concluded that the supplementary motor areas, which are also active during programming and execution of movement sequences in intrapersonal space (33), elaborate programs for motor subroutines necessary in skilled voluntary motion. The convexity parts of the premotor areas are activated when a new motor program is established or a previously learned motor program is modulated. The primary motor area is the exclusive executive locus for voluntary movements of the hand and arm. 5. Voluntary movements in extrapersonal space only are associated with activation of the parietal regions. These areas are assumed to provide information to the motor programming neurons about the demanded direction of motion in extrapersonal space in relation to proprioceptive reference systems. 6. The increase of rCBF in the auditory areas, the inferior frontal regions, and the frontal eye fields during the maze test were ascribed to the processing of auditory information. 7. Both tests are accompanied by a diffuse increase of the hemispheric blood flow (approximately 10%), which is assumed to be a parallel to the commonly known desynchronization of the EEG during mental work.
The fractional increase in cerebral blood flow (CBF) velocity (VCBF) from the control value with 5-min steps of isocapnic hypoxia and hyperoxic hypercapnia was measured by transcranial Doppler in six sea-level native men before and during a 5-day sojourn at 3,810 m altitude to determine whether cerebral vasoreactivity to low arterial O2 saturation (SaO2) gradually increased [as does the hypoxic ventilatory response (HVR)] or diminished (adapted, in concert with known slow fall of CBF) at altitude. A control resting PCO2 value was chosen each day during preliminary hyperoxia to set ventilation at 140 ml.kg-1.min-1 for this and the parallel HVR study, attempting to establish control cerebrospinal fluid (CSF) and brain extracellular fluid pH values unaltered by acclimatization. The relationship of CBF to SaO2 was nonlinear, steepening at a lower SaO2. A hyperbolic equation was used to describe hypoxic cerebrovascular reactivity: fractional VCBF = x[60/ (SaO2-40)-1], where X is the fractional increase of VCBF at 70%.X rose from 0.346 +/- 0.104 (SD) at sea level to 0.463 +/- 0.084 on altitude day 5 (P < 0.05 by paired t-test, justified by the a priori experimental plan). For comparison with CO2 sensitivity, from these X values, we estimate the rise in CBF in response to a 1% fall in SaO2 at 80% to be 1.30% at sea level and 1.74% after 5 days at altitude. CBF sensitivity to increased end-tidal PCO2 rose from 4.01 +/- 0.62%/Torr at sea level to 5.12 +/- 0.79%/Torr on day 5 (P < 0.05), as expected, at the lower PCO2 due to the logarithmic relationship of PCO2 to CSF pH. This change was not significant after correction to log PCO2. We conclude that the cerebral vascular response to acute isocapnic hypoxia may increase during acclimatization at high altitude. The mechanism is unknown but is presumably unrelated to the parallel carotid chemosensitization that, in these subjects, increased the HVR by 60% in the same 5-day period from 0.91 +/- 0.38 to 1.46 +/- 0.59 l.min-1.% fall in SaO2-1).
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.