Acute Brain Injury Is Associated With Prolonged Suppression of Cerebral Blood Flow Oscillations

Abstract

Abstract INTRODUCTION Low-frequency oscillations (LFOs, < 0.1 Hz) in cerebral blood flow (CBF) reflect changes in the coordinated activity of neuronal assemblies. Synchronized LFOs across multiple brain regions can be identified using magnetic resonance imaging to reveal functionally connected networks; however, how LFOs are altered by brain injury is largely unknown. METHODS We quantified changes in LFO magnitude over time in brain-injured patients where CBF was recorded continuously using invasive thermal diffusion flowmetry. Intracranial pressure (ICP), brain tissue oxygen (PbO2), and arterial blood pressure (ABP) were recorded concurrently in all patients. For each epoch of uninterrupted CBF data, the power spectral density within the 0.05 to 0.1 Hz frequency band was calculated. Periods of LFO suppression were defined as occurring when equal to 10% of the total power across all frequencies occurred in the 0.05 to 1 Hz frequency band. Average values of CBF, ICP, PbO2, and ABP were compared between suppressed and nonsuppressed epochs across all patients. RESULTS Twenty-five patients were included in this retrospective observational study. LFO suppression was associated with a lower average CBF (11.3 mL/100 g/min suppressed vs 31.6 mL/100 g/min unsuppressed, P < .0001) and lower average PbO2 (21.6 mm Hg suppressed vs 31.0 mm Hg unsuppressed, P < .0001). In a subset of patients, LFO suppression was associated with intracranial hypertension (ICP 25-60 mm Hg). Patients that regained consciousness and were discharged to acute rehab had a lower median fraction of time spent in the suppressed state (0.03 rehab vs 0.67 death/nursing home, P = .053). CONCLUSION Brain injury is associated with the suppression of low-frequency CBF fluctuations. LFO suppression is associated with periods of physiological distress and may provide a sensitive marker of disrupted brain function. The degree of LFO suppression may have a prognostic significance, and the re-emergence of LFOs after a period of suppression may provide a marker of return of consciousness after coma.