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Age and Sex Differences in Cerebral Blood Flow and Autoregulation after Pediatric Traumatic Brain Injury

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Cerebral Blood Flow, Metabolism, and Head Trauma

Abstract

Traumatic brain injury (TBI) is a global health concern and is the leading cause of traumatic morbidity and mortality in children. Despite a lower overall mortality than in adult traumatic brain injury, the cost to society from the sequelae of pediatric traumatic brain injury is very high. Predictors of poor outcome after traumatic brain injury include altered systemic and cerebral physiology, including altered cerebral hemodynamics. Impaired cerebral hemodynamics including cerebral blood flow and autoregulation following TBI may adversely impact poor outcome and may be age and or sex dependent. Yet, there is a paucity of information regarding changes in cerebral blood flow and cerebral autoregulation after pediatric traumatic brain injury by age and sex. In this chapter, we discuss the impact of pediatric TBI by observations made in children and in a piglet model of fluid percussion injury on normal pediatric cerebral physiology and cerebrovascular pathophysiology, such as CO2 vasoreactivity and pressure autoregulation, focusing on age and sex differences observed in a bench to bedside translational paradigm. The first half of this chapter discusses the present understanding of age- and sex-dependent differences in cerebral hemodynamics in children, and the second half of the chapter presents information on what we have learned about the mechanisms of those age- and sex-related observations made in children.

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Author information

Authors and Affiliations

  1. Departments of Anesthesiology and Critical Care and Pharmacology, University of Pennsylvania, Philadelphia, PA, USA

    William M. Armstead PhD

  2. Department of Anesthesiology, Harborview Medical Center, University of Washington, Seattle, WA, USA

    Monica S. Vavilala MD

  3. Department of Pediatrics, Harborview Medical Center, University of Washington, Seattle, WA, USA

    Monica S. Vavilala MD

Authors
  1. William M. Armstead PhD
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  2. Monica S. Vavilala MD
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Corresponding author

Correspondence to Monica S. Vavilala MD .

Editor information

Editors and Affiliations

  1. , Health Science Specialist, John D. Dingell VA Medical Center, 4646 John R Street, Detroit, 48201, Michigan, USA

    Christian W. Kreipke

  2. School of Medicine, Anatomy and Cell Biology, Wayne State University, 540 East Canfield, Detroit, 48201, Michigan, USA

    Jose A. Rafols

Glossary

CBF

Cerebral blood flow

CBFV

Cerebral blood flow velocity

CMRglu

Cerebral metabolic rate for glucose

CMRO2

Cerebral metabolic rate of oxygen

ICP

Intracranial pressure

MAP

Mean arterial pressure

SBP

Systolic blood pressure

TBI

Traumatic brain injury

TCD

Transcranial Doppler

VMCA

Middle cerebral artery velocity

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Armstead, W.M., Vavilala, M.S. (2013). Age and Sex Differences in Cerebral Blood Flow and Autoregulation after Pediatric Traumatic Brain Injury. In: Kreipke, C., Rafols, J. (eds) Cerebral Blood Flow, Metabolism, and Head Trauma. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4148-9_6

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