Blood pressure gradients in cerebral arteries: A clue to pathogenesis of cerebral small vessel disease
| Autor: | Pablo J. Blanco, Lucas O. Müller, J. David Spence |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Cerebral arteries
030204 cardiovascular system & hematology lacunar 03 medical and health sciences Cerebral circulation 0302 clinical medicine lobar mathematicalmodelling medicine.artery Animals Humans Medicine Arterial Pressure Computer Simulation Cerebral perfusion pressure Brachial artery Cerebral Convexity business.industry Small vessel disease amyloid blood pressure Neurology (clinical) Cardiology and Cardiovascular Medicine Models Cardiovascular Brain Blood flow Anatomy Cerebral Arteries medicine.disease Magnetic Resonance Imaging Blood pressure Cerebral Small Vessel Diseases Hypertension Stroke Lacunar Original Article business Lipohyalinosis 030217 neurology & neurosurgery |
| Zdroj: | Stroke and Vascular Neurology Department of Medicine Publications |
| Popis: | Rationale The role of hypertension in cerebral small vessel disease is poorly understood. At the base of the brain (the ‘vascular centrencephalon’), short straight arteries transmit blood pressure directly to small resistance vessels; the cerebral convexity is supplied by long arteries with many branches, resulting in a drop in blood pressure. Hypertensive small vessel disease (lipohyalinosis) causes the classically described lacunar infarctions at the base of the brain; however, periventricular white matter intensities (WMIs) seen on MRI and WMI in subcortical areas over the convexity, which are often also called ‘lacunes’, probably have different aetiologies. Objectives We studied pressure gradients from proximal to distal regions of the cerebral vasculature by mathematical modelling. Methods and results Blood flow/pressure equations were solved in an Anatomically Detailed Arterial Network (ADAN) model, considering a normotensive and a hypertensive case. Model parameters were suitably modified to account for structural changes in arterial vessels in the hypertensive scenario. Computations predict a marked drop in blood pressure from large and medium-sized cerebral vessels to cerebral peripheral beds. When blood pressure in the brachial artery is 192/113 mm Hg, the pressure in the small arterioles of the posterior parietal artery bed would be only 117/68 mm Hg. In the normotensive case, with blood pressure in the brachial artery of 117/75 mm Hg, the pressure in small parietal arterioles would be only 59/38 mm Hg. Conclusion These findings have important implications for understanding small vessel disease. The marked pressure gradient across cerebral arteries should be taken into account when evaluating the pathogenesis of small WMIs on MRI. Hypertensive small vessel disease, affecting the arterioles at the base of the brain should be distinguished from small vessel disease in subcortical regions of the convexity and venous disease in the periventricular white matter. |
| Databáze: | OpenAIRE |
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