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Cerebral Autoregulation in Stroke

  • Cardiovascular Disease and Stroke (S. Prabhakaran, Section Editor)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Cerebral autoregulation (CA) is a mechanism that maintains cerebral blood flow constant despite fluctuations in systemic arterial blood pressure. This review will focus on recent studies that measured CA non-invasively in acute cerebrovascular events, a feature unique to the transcranial Doppler ultrasound. We will summarize the rationale for CA assessment in acute cerebrovascular disorders and specifically evaluate the existing data on the value of CA measures in relation to clinical severity, guiding management decisions, and prognostication.

Recent Findings

Existing data suggest that CA is generally impaired in various cerebrovascular disorders. In patients with small vessel ischemic stroke, CA has been shown to be impaired in both hemispheres, whereas in large territorial strokes, CA impairment has been limited to the affected hemisphere. In these latter patients, impaired CA is also predictive of secondary complications such as hemorrhagic transformation and cerebral edema, hence worse functional outcome. In patients with carotid stenosis, impaired CA may also be associated with a higher ipsilateral hemispheric stroke risk. CA is also strongly linked to outcome in patients with intracranial hemorrhage. In patients with intraparenchymal hemorrhage, CA impairment correlated with clinical and imaging severity, whereas in those with subarachnoid hemorrhage, CA measures have a predictive value for development of delayed cerebral ischemia and radiographic vasospasm.

Summary

Assessment of CA is increasingly more accessible in acute cerebrovascular disorders and promises to be a valuable measure in guiding hemodynamic management and predicting secondary complication, thus enhancing the care of these patients in the acute setting.

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Authors and Affiliations

  1. Department of Neurology, São João Hospital Center, Porto, Portugal

    Pedro Castro & Elsa Azevedo

  2. Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal

    Pedro Castro & Elsa Azevedo

  3. Department of Neurology, Division of Stroke and Neurocritical, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Ward 12-140, Chicago, IL, 60611, USA

    Farzaneh Sorond

Authors
  1. Pedro Castro
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  2. Elsa Azevedo
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  3. Farzaneh Sorond
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Corresponding author

Correspondence to Farzaneh Sorond.

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Conflict of Interest

Pedro Castro, Elsa Azevedo, and Farzaneh Sorond declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Cardiovascular Disease and Stroke

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Castro, P., Azevedo, E. & Sorond, F. Cerebral Autoregulation in Stroke. Curr Atheroscler Rep 20, 37 (2018). https://doi.org/10.1007/s11883-018-0739-5

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  • DOI: https://doi.org/10.1007/s11883-018-0739-5

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