Cerebral Autoregulation and Neurovascular Coupling in Brain Disorders

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Background

Keeping adequate and constant blood supply to the brain is extremely important to ensure a stable delivery of oxygen and to remove the waste products of metabolism of the brain, especially in patients with brain disorders. Two important mechanisms involving in cerebral hemodynamic management include cerebral autoregulation and neurovascular coupling. Cerebral autoregulation refers to the ability of the brain to keep stable cerebral blood flow despite of changes in cerebral perfusion pressure or arterial blood pressure, and neurovascular coupling adapts cerebral blood flow in accordance with local cortical activity. The two functions may be disturbed in patients in neuronal ICU and cause secondary injuries. For patients with stroke, hypoxia, traumatic brain injury (TBI), or subarachnoid hemorrhage (SAH), etc., cerebral arterioles and capillaries may be damaged, resulting in a lack of blood supply which may further aggravate cell death via blood-brain-barrier damage, inflammatory response, endothelial cell and receptor dysfunction.
Early impairments in cerebral hemodynamics are associated with vasospasm and delayed cerebral infarction (DCI) after SAH which contribute substantially to mortality and morbidity. In other brain diseases, such as reversible cerebral vasoconstriction syndrome (RCVS), a disturbance in the control of the smooth muscle tone of cerebral vessels, may cause sudden and severe headaches due to a sudden constriction of the vessels. Studies already show maintaining blood pressure within the range that optimizes autoregulation could mitigate brain injury after hypoxia and TBI.
However, the mechanisms of impaired cerebral autoregulation and neurovascular coupling during these brain disorders, the time course of changes of these two functions during clinical interventions are still unknown. Further investigations of the two functions, including basic science in pathogenesis, translational techniques of measuring NVC and CA, or personalized treatment strategies may allow for more accurate prediction of these complications.

An effective and prompt monitoring of brain blood perfusion and oxygenation with quantitative metrics of neurophysiologic dynamics would enable early-stage decision and immediate neuroprotective interventions for patients with brain disorders. Cerebral autoregulation (CA) and neurovascular coupling (NVC) are two important functions regulating cerebral blood perfusion. Different methods have been developed for CA and NVC assessment, via transcranial doppler, near infrared spectroscopy, EEG or magnetic resonance imaging (MRI), etc.
However, we still lack a gold standard for CA and NVC monitoring at clinical bedside. A better understanding of how to apply these methods for personalized treatment, such as optimizing blood pressure management, would benefit patients. Additionally, the mechanism of deterioration of CA and NVC in ischemia stroke and other brain injuries remains unclear. Further investigation about the interaction between CA and NVC with clinical interventions may improve patient outcome. Moreover, besides the brain, other organs of the body also need hemodynamic regulation to keep stable blood supply, such as kidney, liver etc. The comparison of autoregulation among different organs under various diseases has raised researchers’ attention. This Research Topic aims to provide the most recent update of the basic science and advanced techniques about CA and NVC, and to introduce the applications of CA and NVC monitoring for patient management in intensive care unit and operating room.

In this Research Topic, we welcome manuscript addressing, but not limited to:
1) Basic science about mechanisms of CA or NVC in patients with brain disorders, such as stroke, hypoxia, TBI, RCVS, vasospasm and DCI after subarachnoid hemorrhage, Alzheimer, etc. ;
2) The time course of changes of CA and NVC during neuroprotective interventions;
3) New techniques of cerebral hemodynamic and neuronal activity monitoring;
4) New algorithms of CA and NVC assessment;
5) Applications of CA or NVC monitoring in brain disorders at bedside, such as individualized management;
6) Comparison of autoregulation among different organs, such as brain, kidney, liver, etc;

Keywords: Cerebral Autoregulation, Neurovascular Coupling, Cerebral Hemodynamics, Brain Diseases, Brain Monitoring

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