Cerebrovascular reactivity and autonomic drive following traumatic brain injury

Lavinio, Andrea; Ene-Iordache, Bogdan; Nodari, Ilaria; Girardini, Alan; Cagnazzi, Elena; Rasulo, Frank; Śmielewski, Piotr; Czosnyka, Marek; Latronico, Nicola

doi:10.1007/978-3-211-85578-2_1

Cited by 38 publications

(26 citation statements)

References 18 publications

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“…In human studies, cerebral blood flow (CBF) was reduced early and continued to exhibit hypoperfusion 14d after TBI 11 . Other vascular findings in TBI patients include loss of autoregulatory capacity 22 , decreased cerebrovascular reactivity 23,24 , and persistent blood brain barrier leakage 25 . Further, in severe human TBI direct observation of the peri-contusional vasculature reported decreased vessel density but no apparent alteration in flow 13 .…”

Section: Discussionmentioning

confidence: 99%

Traumatic brain injury results in acute rarefication of the vascular network

Obenaus

Orantes

et al. 2017

Sci Rep

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The role of the cerebrovascular network and its acute response to TBI is poorly defined and emerging evidence suggests that cerebrovascular reactivity is altered. We explored how cortical vessels are physically altered following TBI using a newly developed technique, vessel painting. We tested our hypothesis that a focal moderate TBI results in global decrements to structural aspects of the vasculature. Rats (naïve, sham-operated, TBI) underwent a moderate controlled cortical impact. Animals underwent vessel painting perfusion to label the entire cortex at 1 day post TBI followed by whole brain axial and coronal images using a wide-field fluorescence microscope. Cortical vessel network characteristics were analyzed for classical angiographic features (junctions, lengths) wherein we observed significant global (both hemispheres) reductions in vessel junctions and vessel lengths of 33% and 22%, respectively. Biological complexity can be quantified using fractal geometric features where we observed that fractal measures were also reduced significantly by 33%, 16% and 13% for kurtosis, peak value frequency and skewness, respectively. Acutely after TBI there is a reduction in vascular network and vascular complexity that are exacerbated at the lesion site and provide structural evidence for the bilateral hemodynamic alterations that have been reported in patients after TBI.

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Section: Discussionmentioning

confidence: 99%

Traumatic brain injury results in acute rarefication of the vascular network

Obenaus

Orantes

et al. 2017

Sci Rep

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“…It has been found that PRx values above a critical level associated with brain vascular deterioration can cause death [20,21]. The crucial threshold for PRx was suggested and recommended by various scientists (i.e., values above 0.2 or 0.25 for PRx being associated with impaired status and those close to zero or negative being associated with intact autoregulation) [22][23][24].…”

Section: Introductionmentioning

confidence: 99%

“…PRx is one of the widely used indices for CA monitoring [15][16][17][18][19][20][21][22][23][24], as no gold standard exists. However, an important limitation of this approach is that it is invasive (i.e., ICP sensors must be inserted into brain ventricles or parenchyma tissue).…”

Section: Introductionmentioning

confidence: 99%

Comparative Study of Novel Noninvasive Cerebral Autoregulation Volumetric Reactivity Indices Reflected by Ultrasonic Speed and Attenuation as Dynamic Measurements in the Human Brain

et al. 2020

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This is a comparative study of two novel noninvasive cerebrovascular autoregulation (CA) monitoring methods based on intracranial blood volume (IBV) changes in the human brain. We investigated the clinical applicability of the new volumetric reactivity index (VRx2), reflected by intracranial ultrasonic attenuation dynamics for noninvasive CA monitoring. The CA was determined noninvasively on 43 healthy participants by calculating the volumetric reactivity index (VRx1 from time-of-flight of ultrasound, VRx2 from attenuation of ultrasound). The VRx was calculated as a moving correlation coefficient between the arterial blood pressure and noninvasively measured IBV slow waves. Linear regression between VRx1 and VRx2 (averaged per participants) showed a significant correlation (r = 0.731, p < 0.0001, 95% confidence interval [0.501–0.895]) in data filtered by bandpass filtering. On the other hand, FIR filtering demonstrated a slightly better correlation (r = 0.769, p < 0.0001, 95% confidence interval [0.611–0.909]). The standard deviation of the difference by bandpass filtering was 0.1647 and bias −0.3444; and by FIR filtering 0.1382 and bias −0.3669. This comparative study showed a significant coincidence of the VRx2 index compared to that of VRx1. Hence, VRx2 could be used as an alternative, cost-effective noninvasive cerebrovascular autoregulation index in the same way as VRx1 values are used.

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“…It has been showed that the HF component is related to the respiratory sinus arrhythmia and vagal activity of the heart while the LF component reflects the global activity of the autonomic nervous system [13,14]. HRV reduction was observed in brain injury patients, both in adult and pediatric patients [15], was associated with prognosis [15,16] and can be used to predict impaired cerebral autoregulation [17]. As the PW are probably a reflex of autonomic dysfunction, the authors hypothesized that there is a relationship between ICP plateau waves and HRV.…”

Section: Introductionmentioning

confidence: 99%

Heart rate variability during plateau waves of intracranial pressure: A pilot descriptive study

Luís

Santos²,

Dias

et al. 2015

2015 37th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC)

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-This study aims to describe heart rate variability during the first episode of plateau waves of intracranial pressure (ICP) in Traumatic Brain Injury (TBI) in order to characterize and identify at bedside this cerebrovascular phenomenon. The general behavior of the heart rate variability (HRV) spectral measures expressed in the medians across patients is concordant with an increased HRV in the latter part of the baseline and plateau wave, followed by a decrease after the event and a new increase during the recovery. In low and high frequency bands the same increase is more marked in the parametric analysis. Interpretation of HRV may help clinicians to better identify the plateau waves and allow earlier management.

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Cerebrovascular reactivity and autonomic drive following traumatic brain injury

Cited by 38 publications

References 18 publications

Traumatic brain injury results in acute rarefication of the vascular network

Traumatic brain injury results in acute rarefication of the vascular network

Comparative Study of Novel Noninvasive Cerebral Autoregulation Volumetric Reactivity Indices Reflected by Ultrasonic Speed and Attenuation as Dynamic Measurements in the Human Brain

Heart rate variability during plateau waves of intracranial pressure: A pilot descriptive study

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