Impaired Dynamic Cerebral Autoregulation in Cerebral Venous Thrombosis.

Jie Chen,Yongjun Wang,Kehui Dong,Xingquan Zhao,Xiping Gong,Yilong Wang,Jia Liu

doi:10.3389/fneur.2020.570306

Abstract

Background: Cerebral autoregulation is crucial in traumatic brain injury, which might be used for determining the optimal intracranial pressure. Cerebral venous thrombosis (CVT) is a cerebral vascular disease with features of high intracranial pressure. However, the autoregulatory mechanism of CVT remains unknown. We aimed to investigate the capacity of cerebral autoregulation in patients with CVT.Methods: This study consecutively enrolled 23 patients with CVT and 16 controls from December 2018 to May 2019. Cerebral autoregulation was assessed by transfer function analysis (rate of recovery/phase/gain) using the spontaneous oscillations of the cerebral blood flow velocity and arterial blood pressure.Results: In total, 76 middle cerebral arteries (MCAs) were investigated, including 44 MCAs in patients with CVT and 32 normal ones. The phase shift estimated in patients with CVT was significantly different from that of the controls (37.37 ± 36.53 vs. 54.00 ± 26.78, p = 0.03). The rate of recovery and gain in patients with CVT were lower than those in controls but without statistical significance.Conclusion: To our knowledge, this is the first time that a study has indicated that patients with CVT were more likely to have impaired cerebral autoregulation. Hence, cautious blood pressure control is required in such patients to prevent hyper- or hypoperfusion.

Highlights

Cerebral venous thrombosis (CVT) is a relatively rare cerebrovascular disease, usually affecting young individuals [1]
After the baseline value stabilized, the data of the Cerebral blood flow velocity (CBFV) and arterial blood pressure (ABP) were recorded at a sample rate of 100 Hz for at least 5 min with the participants breathing spontaneously in supine position
The phase shift of the transfer function analysis showed a significant reduction in patients with CVT, which indicated that cerebral autoregulation was impaired in such patients

Summary

Introduction

Cerebral venous thrombosis (CVT) is a relatively rare cerebrovascular disease, usually affecting young individuals [1]. The clinical presentations vary, the pathogenesis of CVT is partly caused by elevated intracranial pressure, obstruction of the venous blood drainage, and decreased cerebrospinal fluid absorption [2]. Many studies have shown that intracranial hypertension may impair the mechanism of cerebral autoregulation in patients with subarachnoid hemorrhage and traumatic brain injury [3,4,5,6,7]. Cerebral autoregulation is crucial in traumatic brain injury, which might be used for determining the optimal intracranial pressure. Cerebral venous thrombosis (CVT) is a cerebral vascular disease with features of high intracranial pressure. We aimed to investigate the capacity of cerebral autoregulation in patients with CVT

Objectives

Methods

Results

Conclusion