Heptyl-physostigmine enhances basal forebrain control of cortical cerebral blood flow.

This study sought to determine the effect of heptylphysostigmine (H-PHY), a reversible cholinesterase (ChE) inhibitor with greater lipophilicity and longer duration of action than physostigmine, on resting and basal forebrain (BF)-elicited increases in cortical cerebral blood flow (CBF). Laser-doppler flowmetry (LDF) was used to monitor changes in frontal cortical microvascular perfusion in urethane anesthetized rats. Responses were measured before, early after, and 1 hr following H-PHY, 3 mg/kg, i.m. Electrical stimulation (100 microA) of the BF elicited up to 220% increases in CBF at 50 Hz, an effect that was graded with frequency. At 15 min following H-PHY (3 mg/kg) resting cortical CBF was unchanged, whereas BF-elicited increases were potentiated 47% at 50 Hz. At 1 hour, resting cortical CBF remained unchanged, and the BF-elicited responses were remarkably potentiated by 354% at 10 Hz and 67% at 50 Hz. Acetylcholinesterase (AChE) activity measured in the tissue directly beneath the LDF probe was decreased by 84% at a time when these CBF responses were enhanced. These data suggest that H-PHY substantially enhances the regulation of cortical CBF by the BF, an effect that may be linked to inhibition of cortical AChE activity. This enhancement of cortical CBF may contribute to the efficacy of H-PHY as a treatment for Alzheimer's disease.     

Nitric oxide synthase in cerebral ischemia

The results of our continuing studies on the role of nitric oxide (NO) in cellular mechanisms of ischemic brain damage as well as related reports from other laboratories are summarized in this paper. Repetitive ip administration ofN ^G-nitro-L-arginine (L-NNA), a NO synthase (NOS) inhibitor, protected against neuronal necrosis in the gerbil hippocampal CA1 field after transient forebrain ischemia with a bell-shaped response curve, the optimal dose being 3 mg/kg. Repeated ip administration of L-NNA also mitigated rat brain edema or infarction following permanent and transient middle cerebral artery (MCA) occlusion with a U-shaped response. The significantly ameliorative dose-range and optimal dose were 0.01–1 mg/kg and 0.03 mg/kg, respectively. Studies using a NO-sensitive microelectrode revealed that NO concentration in the affected hemisphere was remarkably increased by 15–45 min and subsequently by 1.5–4 h after MCA occlusion. Restoration of blood flow after 2 h-MCA occlusion resulted in enhanced NO production by 1–2 h after reperfusion. Administration of L-NNA (1 mg/kg, ip) diminished the increments in NO production during ischemia and reperfusion, leading to a remarkable reduction in infarct volume. In brain microvessels obtained from the affected hemisphere, Ca²⁺-dependent constitutive NOS (cNOS) was activated significantly at 15 min, and Ca²⁺-independent inducible NOS (iNOS) was activated invariably at 4 h and 24 h after MCA occlusion. Two hour reperfusion following 2 h-MCA occlusion caused more than fivefold increases in cNOS activity with no apparent alterations in iNOS activity. Thus, we report here based on available evidence that there is good reason to think that NOS activation in brain microvessels may play a role in the cellular mechanisms underlying ischemic brain injury.     

Microcirculation in experimental brain oedema assessed by laser-Doppler flowmetry

Abstract

Continuous measurement of CBV and CBF by means of laser-Doppler flowmetry was performed to analyse the cerebrovascular response to water accumulation during brain infusion oedema in cats. The presence of an oedema generator elicits a continuous reduction of CBV and a transient reduction of CBF. With cessation of this mechanical force of oedema production, CBV and CBF returned to control levels. These results indicate that excess accumulation of water in brain tissue by itself does not decrease CBF even when the driving pressure of oedema fluid is present, but that brain oedema attenuates CBV only when a pressure gradient exists. These results suggest that there are microcirculatory changes in brain oedema before and after removal of the oedema generating focus. The laser—Doppler flow method is a useful technique for the continuous assessment of tissue perfusion. [Neurol Res 1993; 15: 264—268]     

Nitric oxide synthase activity in human pituitary adenomas

OBJECTIVES: The purpose of the present study was to examine human pituitary adenomas for nitric oxide synthase (NOS) activity by immunohistochemical and enzymatic methods. MATERIALS AND METHODS: Adenomatous tissue from 16 patients were obtained during operation and stained immunohistochemically for hormone production and for the three NOS isoenzymes. Cell types that expressed NOS immunoreactivity (IR) were identified, and the NOS isoform was noted. NOS activity was measured enzymatically by the conversion of L-arginine to L-citrulline in tissue samples. RESULTS: Endothelial cells of pituitary adenomas showed increase of eNOS IR compared with control tissue. The nNOS and iNOS IR were the same in adenomas and controls. There was no correlation between NOS IR and NOS activity measured enzymatically and the endocrine activity of the tumour or other clinical variables. CONCLUSION: The observation of increased eNOS IR in endothelial cells of adenomas may suggest that NO plays a role in the regulation of blood flow in pituitary adenomas.     

激光多普勒血流测定仪监测Wistar大鼠丘脑外侧背核区血流量

目的测定Wistar大鼠丘脑外侧背核区(LD区)血流量正常值范围。方法Wistar大鼠按性别和体重分4组。立体定向下将LDF探头定位于双侧LD区。结果119只大鼠共计238个LD区LDF值为(88±27)PU,数据近似正态分布。不同性别组间、不同体重组间以及同一个体双侧LD区LDF测量值均无显著性差别(P＜0.10)。结论Wistar大鼠LD区LDF测量正常值范围为44～143PU,不同实验样本间及同一个体双侧LD区LDF监测可互为对照。     

Basal forebrain nitric oxide synthase (NOS)-containing neurons project to microvessels and NOS neurons in the rat neocortex: cellular basis for cortical blood flow regulation

Stimulation of basal forebrain neurons results in local increases in cortical cerebral blood flow that are dependent upon cholinergic and nitrergic mechanisms. In the present study, we investigated the possibility that basal forebrain nitric oxide synthase (NOS)-containing neurons project to microvessels and NOS interneurons in the rat cerebral cortex. We performed quisqualic (QUIS) acid lesions of the basal forebrain and evaluated their effects on cortical NOS immunostained nerve terminals, with emphasis on those associated with microvessels and NOS interneurons, both at the light and/or electron microscopic levels. The results show that basal forebrain NOS neurons provide about one third of the overall cortical NOS innervation. Further, the data indicate that basalocortical NOS fibres establish privileged associations with microvessels and NOS neurons, as respective denervations of 60 and 45% were observed following lesion. At the electron microscopic level, most perivascular NOS neuronal elements corresponded to nerve terminals and a majority ( approximately 25%) of these were located in the immediate vicinity of the blood vessels, similar to the perivascular distribution reported previously for classic neurotransmitters/neuromediators. NOS terminals abutting on cortical NOS neurons were primarily nonjunctional. Altogether, these results raise the possibility that not only cholinergic but also nitrergic basal forebrain neurons are involved in the flow response observed following stimulation of the basal forebrain. Further, they suggest interactions between basalocortical and intracortical NOS neurons. We conclude that these interactions are involved in the spatial and temporal regulation of cortical perfusion following basal forebrain activation, and that they may become dysfunctional in pathologies such as Alzheimer's disease which affects both the basal forebrain and the cortical NOS neurons.     

7-nitroindazole reduces cerebral blood flow following chronic nitric oxide synthase inhibition

Blood flow and glucose utilization were measured in rat brain after chronic L-NAME treatment followed by acute 7-nitroindazole. Following chronic L-NAME, blood flow was not significantly different from control. Treatment with acute 7-nitroindazole reduced blood flow to the same extent in both chronic saline and L-NAME groups. Glucose utilization was unaffected. These results suggest that residual NOS activity in brain is sufficient to provide tonic, NO-dependent cerebrovascular dilator tone.     

Laser Doppler monitoring of cerebral blood flow

Abstract

The clinical management of cerebral hemodynamic status has become more important, as well as more complex, in recent years. In response", monitoring systems for neurological patients have grown increasingly sophisticated. Unfortunately the capability of monitoring cerebral blood flow is absent in commercially available monitoring systems at this time. Various investigators have demonstrated that laser Doppler systems are capable of meeting this need. We present here a summary of laser Doppler technology and also a review of the progress in application of this technology to provide meaningful input for clinical decision making. Recent clinical experience and advances in instrumentation design suggest that laser Doppler monitoring of cerebral blood flow may soon become routine in neurological intensive care settings. [Neurol Res 1996; 18: 251–255]     

Cerebral blood flow regulation under activation of the primary somatosensory cortex during electrical stimulation of the forearm

Abstract

Coupling of neuronal activity to cerebral blood flow (CBF) is widely accepted, but the exact mechanism is still under investigation. We assessed the responses of CBF coupled with electrical activity over the primary somatosensory cortex (S-l) during electrical stimulation of the contralateral forearm in cats. CBF in S-I was monitored using laser-Doppler flowmetry (LDF), and electrical activity was recorded with a tungsten microelectrode. The effects of varying stimulus intensity and frequency were examined to assess the optimal stimulation parameters. CBF increased within 10 sec after onset of stimulation, sustained the plateau level, and returned to the pre-stimulus level after cessation of stimulation. The maximum response was obtained at 4 Hz under a constant intensity. Optimal stimulus intensity at 4 Hz ranged from 8 to 10 V. At intensity higher than 10 V, CBF increases reached a near-plateau level, while mean arterial blood pressure (MABP) decreased slightly. Electrical activity was recorded at the same restricted area where CBF increased. Low frequency components of the power spectrum of electrical activity increased as the CBF increase became greater. A tight coupling of CBF increases to neuronal activation is suggested, and CBF regulation may be affected by stimulation parameters. [Neurol Res 1999; 21: 579–584]     

Integrative cerebral blood flow regulation in ischemic stroke

Optimizing cerebral perfusion is key to rescuing salvageable ischemic brain tissue. Despite being an important determinant of cerebral perfusion, there are no effective guidelines for blood pressure (BP) management in acute stroke. The control of cerebral blood flow (CBF) involves a myriad of complex pathways which are largely unaccounted for in stroke management. Due to its unique anatomy and physiology, the cerebrovascular circulation is often treated as a stand-alone system rather than an integral component of the cardiovascular system. In order to optimize the strategies for BP management in acute ischemic stroke, a critical reappraisal of the mechanisms involved in CBF control is needed. In this review, we highlight the important role of collateral circulation and re-examine the pathophysiology of CBF control, namely the determinants of cerebral perfusion pressure gradient and resistance, in the context of stroke. Finally, we summarize the state of our knowledge regarding cardiovascular and cerebrovascular interaction and explore some potential avenues for future research in ischemic stroke.     

Principles of cerebral oxygenation and blood flow in the neurological critical care unit

Cerebrovascular disease and trauma are leading causes of death in the United States. In addition to the initial insult to the brain, disturbances of cerebral oxygenation and metabolism underlie many of the secondary pathophysiological processes that increase both morbidity and mortality. Therefore, researchers and clinicians have sought to obtain a more thorough understanding of the physiological and biochemical principles of cerebral oxygenation and metabolism. New technologies capable of offering continuous and quantitative assessment of cerebral oxygenation may improve clinical outcomes. In this article, we review the physiological principles of cerebral metabolism, cerebral blood flow and their metabolic coupling, and cerebral oxygenation, with particular emphasis on variables that could be monitored and managed in an intensive care unit setting. BWH Neurosurgery Group in alphabetical order are Ian F. Dunn, Dilantha B. Ellegala, Jonathan F. Fox, and Dong H. Kim.     

Cortical infarct volume is dependent on the ischemic reduction of perifocal cerebral blood flow in a three-vessel intraluminal MCA occlusion/reperfusion model in the rat

Occlusion of the middle cerebral artery (MCA) causes a reduction of cerebral blood flow (CBF), which shows a progressive decrease from the periphery to the core of the MCA territory. The severity of ischemia is dependent on the duration of the ischemic episode and degree of CBF reduction. Fixing the ischemic episode to 1 h, we have examined whether or not cortical infarct size was related to the degree of CBF reduction in a perifocal cortical area in rats. One-hour intraluminal MCA occlusion accompanied with bilateral common carotid artery (CCA) occlusion (three-vessel occlusion/reperfusion model) was carried out in Sprague-Dawley rats and CBF was monitored with laser-Doppler flowmetry in the fronto-parietal cortex, an area which is perifocal to the core of the MCA territory. Finally, infarct size was measured 7 days later and was related to the corresponding CBF decrease. Sequential ipsilateral CCA, MCA and contralateral CCA occlusions produced reductions of CBF to 96%, 52% and 33% of baseline, respectively. Cortical infarct volume was found to be dependent on the corresponding reduction of perifocal cortical CBF during the ischemic episode. These results show that the reduction of CBF in the periphery of the MCA territory during 1-h focal ischemia determines infarct size in a three-vessel occlusion/reperfusion model.     

Prostacyclin, indomethacin and the cerebral circulation

The effect of intracarotid prostacyclin (PGI2) on cerebral blood flow (CBF) was measured by the 133xenon intracarotid injection technique in 8 baboons. Intracarotid prostacyclin increased CBF by 22% at 10(-7) g/kg/min and by 71% at 5 x 10(-6) g/kg/min, accompanied by systemic hypotension and tachycardia. The effects of PGI2 (10(-7) g/kg/min) were not potentiated by transient opening of the blood-brain barrier with the intracarotid hypertonic urea technique. At hypercapnia, the vasoconstrictor effect of indomethacin on the cerebral circulation was reversed by PGI2. These results support our suggestion that a prostaglandin, in particular PGI2, is required for hypercapnia to produce full cerebral vasodilatation. In separate experiments, following craniectomy in 5 cats, PGI2, but not its stable metabolite 6-keto-PGF1 alpha, dilated pial arterioles when locally injected into the mock CSF overlying the arteriole.     

Action of 4-aminopyridine on the cerebral circulation

4-Aminopyridine (4-AP) facilitates both inhibitory and excitatory synaptic activity in the central nervous system, and may, therefore, be a drug of potential therapeutic use in brain diseases with a disturbed synaptic transmission. In the present study the vasomotor effects upon isolated feline brain vessels, and regional cerebral blood flow and brain cortical metabolism in rats were examined. At high concentrations (above 10-6 M) a minor vasoconstriction was obtained of isolated pial vessels. Measurements of regional cerebral blood flow using the 14C-ethanol technique resulted in a significant increase in blood flow of caudate nucleus (93%), thalamus (74%) and cerebellum (82%). The arteriovenous oxygen difference of cortical tissue was reduced from 3.20 mmol O2/ml to 1.69 mmol O2/ml by 4-AP. This was not associated with an increase in cortical blood flow. Calculation of the cortical metabolic rate of oxygen, however, failed to demonstrate any significant change.     

慢性脑供血不足患者的脑血流及颈动脉粥样硬化研究

目的研究慢性脑供血不足患者的脑血流及颈动脉粥样硬化特点.方法分别对100例慢性脑供血不足患者和100例正常对照者及100例脑梗死患者行颈动脉彩色多普勒及经颅多普勒检查,并测量相关指标.结果观察组颈动脉粥样斑块发生率为60%,内膜粗糙率为31%,颈动脉内膜中层厚度＞1.00 mm者占24%,颈动脉狭窄率为23%,颅内血流异常率为60%,颅内血管狭窄率为16%,而正常对照组分别为18%,4%,4%,6%,8.1%,4.8%;脑梗死对照组分别为90%,62%,51%,45%,88.9%,50%,观察组与正常对照组比较有显著差异(P＜0.01),脑梗死对照组与观察组比较也有显著差异(P＜0.01).结论慢性脑供血不足是动脉粥样硬化过程的一个阶段,是缺血性脑卒中的预兆.     

Cerebral blood flow increases evoked by electrical stimulation of rat cerebellar cortex: relation to excitatory synaptic activity and nitric oxide synthesis

The purpose of this study was to examine mechanisms involved in the coupling of neuronal activity to cerebral blood flow (CBF). CBF was measured in rat cerebellum using laser-Doppler flowmetry during stimulus-evoked neuronal activity and related to the distribution of the extracellular field potential. Local electrical stimulation of the cerebellar cortex activated a narrow beam of parallel fibers (PFs) 100 μm across and evoked increases of CBF along (On-B) and perpendicular (Off-B) to the beam. Increases of CBF and field potentials were recorded for a distance of up to 1500 μm along the activated beam, and perpendicular to the beam, in a zone approximately 1000 μm wide, i.e. about 10 times wider than the zone in which synaptic excitation took place. CBF increased as a function of stimulus frequency up to 75 Hz, the response being larger On-B than Off-B. TTX abolished both the field potentials and the CBF responses at all frequencies, suggesting that action potentials were mechanistically related to the evoked CBF increases. CBF changes were unchanged by picrotoxin, a blocker of GABA_A receptors, consistent with the idea that inhibitory synaptic activity does not contribute to CBF increases. The latency to the CBF rise was much shorter On-B than Off-B for the same distance from the stimulating electrode. This may suggest that the CBF response Off-B is dependent on diffusion of vasoactive substances from neuronal structures activated by the parallel fibers On-B. Nitric oxide (NO) synthase inhibition withN^G-nitro-l-Arginine increased the time latency to onset of CBF rise by 2–4 times and attenuated the evoked CBF increase by approximately 50%. Sodium nitroprusside, a NO donor, increased baseline CBF, but did not reverse the effects ofl-NNA. Thus the initial part of the evoked CBF rise is probably mediated by NO, which also contributes to the later part of the response. This study provides insight into the distribution and mechanism of neurally evoked increases of CBF, of putative importance for the interpretation of activation studies in animals and humans.     

Regional cerebral blood flow during cortical spreading depression in rat brain: increased reactive hyperperfusion in low-flow states

The purpose of the present study was to characterize the initial vascular events accompanying cortical spreading depression (CSD) of the rat brain. Regional cerebral blood flow (rCBF) was measured during the first 1–2 min of CSD using ¹⁴C-iodoantipyrine autoradiography. The material included a reference group, and 4 groups where rCBF was altered by indomethacin treatment, hypo- or hypercapnia, or one previous episode of CSD. rCBF did not change prior to, or during the onset of CSD. Thirty seconds later, rCBF increased depending on the pre-existing level of blood flow, i.e. the rise of rCBF was pronounced at depressed flow levels, but small or absent at normal or high flow levels. The prevalent view that CSD is intimately associated with vasodilatation was accordingly not supported. The activated rCBF in normocapnic rats ranged between 93 and 175 ml/100g/min, supra normal values were the exception rather than the rule. The rCBF rise, when present, probably succeeds a period of brain hypoxia, and should be classified as a reactive hyperfusion. The results together with earlier clinical and experimental findings, support that CSD may serve as experimental migraine model.     

血液光量子疗法对局灶性脑缺血大鼠大脑皮层局部血流量和脑水肿的影响

本文动态观测了光量子疗法治疗血栓栓塞性脑缺血大鼠,大脑皮层局部血流量(rCBF)及脑水肿的变化。结果:缺血6小时经光量子血液治疗2小时后,rCBF于注后30min明显增加,达19.78％(P<0.01),以后各点维持在一定水平,2小时增加到19.30(P<0.05)。脑组织比重:缺血中心区未见明显改善(P>0.1)而半暗区组织比重非常明显增加(P<0.001),可见水肿明显减轻。说明光量子疗法增加rCBF,减轻半暗区水肿。     

Regulation of regional cerebral blood flow by cholinergic fibers originating in the basal forebrain

The intracranial neural vasodilative system of cholinergic fibers projecting from the basal forebrain to the cortex was discovered by Biesold, Inanami, Sato and Sato (Biesold, D., Inanami, O., Sato, A., Sato, Y., 1989. Stimulation of the nucleus basalis of Meynert increases cerebral cortical blood flow in rats. Neurosci. Lett. 98, 39-44) using laser Doppler flowmetry in anesthetized rats. This cholinergic vasodilative system, which operates by increasing extracellular ACh release, relies upon activation of both muscarinic and nicotinic cholinergic receptors in the parenchyma of the cortex. Further, the involvement of nitric oxide in this cholinergic vasodilation, indicates the necessity to this system of neurons, which contain nitric oxide synthase. The increase in cortical blood flow elicited by this cholinergic vasodilative system is independent of systemic blood pressure and is not coupled to cortical metabolic rates. This cholinergic vasodilative system may be activated by somatic afferent stimulation. Most of the data presented here were obtained in anesthetized animals.