This e-book will review special features of the cerebral
circulation and how they contribute to the physiology of the brain.
It describes structural and functional properties of the cerebral
circulation that are unique to the brain, an organ with high
metabolic demands and the need for tight water and ion homeostasis.
Autoregulation is pronounced in the brain, with myogenic, metabolic
and neurogenic mechanisms contributing to maintain relatively
constant blood flow during both increases and decreases in
pressure. In addition, unlike peripheral organs where the majority
of vascular resistance resides in small arteries and arterioles,
large extracranial and intracranial arteries contribute
significantly to vascular resistance in the brain. The prominent
role of large arteries in cerebrovascular resistance helps maintain
blood flow and protect downstream vessels during changes in
perfusion pressure. The cerebral endothelium is also unique in that
its barrier properties are in some way more like epithelium than
endothelium in the periphery. The cerebral endothelium, known as
the blood-brain barrier, has specialized tight junctions that do
not allow ions to pass freely and has very low hydraulic
conductivity and transcellular transport. This special
configuration modifies Starling's forces in the brain
microcirculation such that ions retained in the vascular lumen
oppose water movement due to hydrostatic pressure. Tight water
regulation is necessary in the brain because it has limited
capacity for expansion within the skull. Increased intracranial
pressure due to vasogenic edema can cause severe neurologic
complications and death.
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