Department of Neurology and Neurophysiology, University Medical Center Freiburg, Germany; Department of Neurology and Clinical Neurophysiology, Medical Center Esslingen, Academic Teaching Hospital of the University of Tübingen, Germany.
Department of Neurology and Neurophysiology, University Medical Center Freiburg, Germany.
Brain Res. 2019 Aug 15;1717:60-65. doi: 10.1016/j.brainres.2019.04.014. Epub 2019 Apr 15.
Cerebral amyloid angiopathy (CAA) might disturb the sensitive mechanism of cerebral pressure autoregulation. This study examines whether dynamic cerebral autoregulation (CA) is impaired in the posterior or anterior circulation of CAA patients. Fifteen patients with known CAA on magnetic resonance imaging (MRI) and 14 age-matched controls were examined with transcranial Doppler. Dynamic CA was assessed in the middle (MCA) and posterior cerebral artery (PCA) via transfer function phase and gain during respiratory-induced 0.1 Hz oscillations of arterial pressure. Within the patient group, 4 patients showed additional microbleeds in the basal ganglia on the MRI performed within the study (pure CAA vs mixed microbleeds). PCA phase was significantly lower in patients compared with controls (p = 0.018), particularly in patients with pure CAA (p = 0.0034). MCA values showed a similar but non-significant trend towards lower phase in patients with pure CAA. Poorer phase was associated with a higher number of microbleeds on MRI (MCA r = -0.57, p = 0.027; PCA r = -0.52, p = 0.098) and superficial cortical siderosis (PCA: p = 0.0025). In conclusion, dynamic cerebral autoregulation is impaired in patients with CAA. The degree of impairment is associated with the extent of cerebral microbleeds.
脑淀粉样血管病 (Cerebral amyloid angiopathy, CAA) 可能会干扰脑压力自动调节的敏感机制。本研究旨在探讨 CAA 患者的大脑后循环或前循环的动态脑自动调节 (Cerebral Autoregulation, CA) 是否受损。15 例经磁共振成像 (Magnetic Resonance Imaging, MRI) 确诊为 CAA 的患者和 14 名年龄匹配的对照者接受经颅多普勒检查。通过动脉压力呼吸诱导 0.1Hz 振荡时传递函数的相位和增益，评估大脑中动脉 (Middle Cerebral Artery, MCA) 和大脑后动脉 (Posterior Cerebral Artery, PCA) 的动态 CA。在患者组中，4 名患者在研究期间进行的 MRI 上显示基底节区有额外的微出血（纯 CAA 与混合微出血）。与对照组相比，患者的 PCA 相位明显降低（p=0.018），尤其是纯 CAA 患者（p=0.0034）。MCA 值也显示出类似但无统计学意义的低相位趋势。较差的相位与 MRI 上更多的微出血（MCA r=-0.57, p=0.027；PCA r=-0.52, p=0.098）和皮质浅铁质沉着症（PCA：p=0.0025）相关。总之，CAA 患者的动态脑自动调节受损。受损程度与脑微出血的程度相关。
