WordNet

the force applied to a unit area of surface; measured in pascals (SI unit) or in dynes (cgs unit); "the compressed gas exerts an increased pressure" (同)pressure level, force per unit area
an oppressive condition of physical or mental or social or economic distress
the somatic sensation that results from applying force to an area of skin; "the sensitivity of his skin to pressure and temperature was normal" (同)pressure_sensation
a force that compels; "the public brought pressure to bear on the government"
of or relating to the cerebrum or brain; "cerebral hemisphere"; "cerebral activity"
involving intelligence rather than emotions or instinct; "a cerebral approach to the problem"; "cerebral drama" (同)intellectual
pumping a liquid into an organ or tissue (especially by way of blood vessels)

PrepTutorEJDIC

〈U〉『押すこと』,『押しつけること』,圧搾,圧縮;〈C〉〈U〉『圧力』,圧力の強さ / 〈U〉『圧迫』,『強制』 / 〈U〉(不快な)圧迫感 / 〈C〉〈U〉(精神的な)重荷,苦脳;(時間・金銭的)切迫 / 〈U〉多忙,あわただしさ / 《おもに米》…‘に'圧力をかける,強制する(《英》pressurise)
大脳の,脳の / 頭脳的な,知的な

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/11/07 06:55:40」(JST)

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Cerebral perfusion pressure, or CPP, is the net pressure gradient causing cerebral blood flow to the brain (brain perfusion). It must be maintained within narrow limits because too little pressure could cause brain tissue to become ischemic (having inadequate blood flow), and too much could raise intracranial pressure (ICP).

Definitions[edit]

The cranium is a box with three components, Blood, Cerebral Spinal Fluid, and very soft tissue (brain). While both the blood and CSF have poor compression capacity, the brain is easily compressible. Every increase of ICP change tissue perfusion and increase stroke event. Comparisons of the relation between brain and body weights among extant mammals show that brain sizes have not increased as much as body sizes.http://www.sciencemag.org/content/220/4603/1302

From resistance[edit]

CPP can be defined as the pressure gradient causing cerebral blood flow (CBF) such that

where:

CVR is cerebrovascular resistance

By intracranial pressure[edit]

An alternative definition of CPP is:^[1]

where:

MAP is mean arterial pressure

ICP is intracranial pressure

This definition may be more appropriate if considering the circulatory system in the brain as a Starling resistor, where an external pressure (in this case, the intracranial pressure) causes decreased blood flow through the vessels. In this sense, more specifically, the cerebral perfusion pressure can be defined as either:

(if ICP is higher than JVP)

orL

(if JVP is higher than ICP).

Physiologically, increased intracranial pressure (ICP) causes decreased blood perfusion of brain cells by mainly two mechanisms:

Increased ICP constitutes an increased interstitial hydrostatic pressure that, in turn, causes a decreased driving force for capillary filtration from intracerebral blood vessels.
Increased ICP compresses cerebral arteries, causing increased cerebrovascular resistance (CVR).

FLOW Ranging from 20ml 100g-1 min-1 in white matter to 70ml 100g-1 min-1 in grey matter.

Autoregulation[edit]

Static autoregulation: Under normal circumstances (MAP between 60 to 150 mmHg and ICP about 10 mmHg), average cerebral blood flow (e.g. the average recorded over 5 minutes or over hours) is relatively constant due to protective autoregulation.^[2]^[3] However, although the classic 'autoregulation curve' proposed by Lassen et al. suggests that CBF is fully stable between these blood pressure values (known also as the limits of autoregualtion), in fact CBF may vary as much as 10% below and above its average within this range.^[4] Outside of the limits of autoregulation, raising MAP raises CPP and raising ICP lowers it (this is one reason that increasing ICP in traumatic brain injury is potentially deadly). CPP is normally between 70 and 90 mmHg in an adult human, and cannot go below 70 mmHg(interruption production of Cerebral Spinal Fluid) for a sustained period without causing ischemic brain damage,^[5]^[6] although some authorities regard 50-150 mmHg as a normal range for adults.^[2] Children require pressures of at least 60 mmHg.^[5]

Within the autoregulatory range, as CPP falls there is, within seconds, vasodilatation of the cerebral resistance vessels, a fall in cerebrovascular resistance and a rise in cerebral-blood volume (CBV), and therefore CBF will return to baseline value within seconds (see as ref. Aaslid, Lindegaard, Sorteberg, and Nornes 1989: http://stroke.ahajournals.org/cgi/reprint/20/1/45.pdf). These adaptations to rapid changes in blood pressure (in contrast with changes that occur over periods of hours or days) are known as dynamic cerebral autoregulation.^[4]

References[edit]

^ Steiner, L. A.; Andrews, P. J. (2006). "Monitoring the injured brain: ICP and CBF". British Journal of Anaesthesia 97 (1): 26–38. doi:10.1093/bja/ael110. PMID 16698860. edit
^ ^a ^b Steiner LA, Andrews PJ (2006). "Monitoring the injured brain: ICP and CBF". British Journal of Anaesthesia 97 (1): 26–38. doi:10.1093/bja/ael110. PMID 16698860.
^ Duschek S, Schandry R (2007). "Reduced brain perfusion and cognitive performance due to constitutional hypotension". Clinical Autonomic Research 17 (2): 69–76. doi:10.1007/s10286-006-0379-7. PMC 1858602. PMID 17106628.
^ ^a ^b van Beek AH, Claassen JA, Rikkert MG, Jansen RW. Cerebral autoregulation: an overview of current concepts and methodology with special focus on the elderly. J Cereb Blood Flow Metab. 2008 Jun;28(6):1071-85
^ ^a ^b Tolias C and Sgouros S. 2003. "Initial Evaluation and Management of CNS Injury." Emedicine.com. Retrieved on March 19, 2007
^ Czosnyka M, Pickard JD (2004). "Monitoring and interpretation of intracranial pressure". Journal of Neurology, Neurosurgery, and Psychiatry 75 (6): 813–821. doi:10.1136/jnnp.2003.033126. PMC 1739058. PMID 15145991.

Others[edit]

Sanders MJ and McKenna K. 2001. Mosby’s Paramedic Textbook, 2nd revised Ed. Chapter 22, "Head and Facial Trauma." Mosby.
Walters, FJM. (1998). "Intracranial Pressure and Cerebral Blood Flow". Physiology (8, Article 4). Retrieved 10 February 2011.

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 成人における頭蓋内圧亢進の評価およびマネージメント evaluation and management of elevated intracranial pressure in adults
2. 急性重度外傷性脳損傷のマネージメント management of acute severe traumatic brain injury
3. 小児における頭蓋内圧亢進（ICP） elevated intracranial pressure icp in children
4. 頸動脈内膜剥離術および頸動脈ステント留置術の麻酔 anesthesia for carotid endarterectomy and carotid stenting
5. 虚血性脳卒中の病態生理 pathophysiology of ischemic stroke

English Journal

Blood pressure decrease correlates with tau pathology and memory decline in hypertensive elderly.

Glodzik L, Rusinek H, Pirraglia E, McHugh P, Tsui W, Williams S, Cummings M, Li Y, Rich K, Randall C, Mosconi L, Osorio R, Murray J, Zetterberg H, Blennow K, de Leon M.SourceDepartment of Psychiatry, Center for Brain Health, New York University School of Medicine, New York, NY, USA; Department of Radiology, New York University School of Medicine, New York, NY, USA. Electronic address: lidia.glodzik@nyumc.org.
Neurobiology of aging.Neurobiol Aging.2014 Jan;35(1):64-71. doi: 10.1016/j.neurobiolaging.2013.06.011. Epub 2013 Aug 19.
In hypertension (HTN), cerebral blood flow regulation limits are changed, and the threshold for blood pressure (BP) at which perfusion is safely maintained is higher. This shift may increase the brain's vulnerability to lower BP in subjects with vascular disease. We investigated whether longitudinal
PMID 23969178

Aortic outflow cannula tip design and orientation impacts cerebral perfusion during pediatric cardiopulmonary bypass procedures.

Menon PG, Antaki JF, Undar A, Pekkan K.SourceDepartment of Biomedical Engineering, Carnegie Mellon University, 700 Technology Drive, #4319, Pittsburgh, PA, 15219, USA.
Annals of biomedical engineering.Ann Biomed Eng.2013 Dec;41(12):2588-602. doi: 10.1007/s10439-013-0857-8. Epub 2013 Jul 2.
Poor perfusion of the aortic arch is a suspected cause for peri- and post-operative neurological complications associated with cardiopulmonary bypass (CPB). High-speed jets from 8 to 10FR pediatric/neonatal cannulae delivering ~1 L/min of blood can accrue sub-lethal hemolytic damage while also subje
PMID 23817768

Central artery stiffness, neuropsychological function, and cerebral perfusion in sedentary and endurance-trained middle-aged adults.

Tarumi T, Gonzales MM, Fallow B, Nualnim N, Pyron M, Tanaka H, Haley AP.SourceaDepartment of Kinesiology and Health Education bDepartment of Psychology cImaging Research Center, The University of Texas at Austin dMedicine in Motion, Austin, Texas, USA.
Journal of hypertension.J Hypertens.2013 Dec;31(12):2400-9. doi: 10.1097/HJH.0b013e328364decc.
BACKGROUND: Midlife vascular disease risk is a strong risk factor for late-life dementia. Central arterial stiffness, a hallmark of vascular aging, is associated with accelerated brain aging and cognitive decline. Habitual aerobic exercise is an effective lifestyle strategy to reduce central arteria
PMID 24220591

Japanese Journal

Significance of Differences Between Brain Temperature and Core Temperature (Delta T) During Mild Hypothermia in Patients With Diffuse Axonal Injury

SUEHIRO Eiichi,FUJISAWA Hirosuke,KOIZUMI Hiroyasu,NOMURA Sadahiro,KAJIWARA Koji,FUJII Masami,SUZUKI Michiyasu
Neurologia medico-chirurgica = 神経外科 51(8), 551-555, 2011-08-15
NAID 10029338156

小児開心術の下半身循環停止を伴う片側脳灌流法の検討

新美保子,柏公一,谷田勝志,深谷碧,久保仁,玉井久義,金信秀,蜷川純,北堀和男,村上新
体外循環技術 = The journal of extra-corporeal technology 38(1), 19-22, 2011-03-01
NAID 10028197808

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★リンクテーブル★

リンク元	「脳灌流圧」「CPP」
関連記事	「perfusion」「cerebral」「pressure」

「脳灌流圧」

　　[★]

英: cerebral perfusion pressure CPP
同: cranial perfusion pressure？、脳組織灌流圧？

[show details]

脳灌流圧 : 約 24,700 件
脳組織灌流圧 : 12 件
脳灌流圧 CPP : 96 件
脳組織灌流圧 CPP : 4 件
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脳組織灌流圧 cerebral perfusion pressure : 2 件

脳血流の駆動力となる脳動脈圧と脳組織圧の差

「CPP」

　　[★]

「perfusion」

　　[★]

n.

(ある臓器や容器の内部に液体を流して回収すること)灌流、潅流、灌流適用、パーフュージョン

関: perfuse、superfuse、superfusion

同: Q

「cerebral」

　　[★]

adj.

大脳の、大脳性の、脳性の、脳の

関: brain、cerebri、cerebro、cerebrum、encephalic、encephalo、encephalon

「pressure」

　　[★]

n.

圧力

[1] Steiner, L. A.; Andrews, P. J. (2006). "Monitoring the injured brain: ICP and CBF". British Journal of Anaesthesia 97 (1): 26–38. doi:10.1093/bja/ael110. PMID 16698860. edit

[Steiner-2] Steiner LA, Andrews PJ (2006). "Monitoring the injured brain: ICP and CBF". British Journal of Anaesthesia 97 (1): 26–38. doi:10.1093/bja/ael110. PMID 16698860.

[3] Duschek S, Schandry R (2007). "Reduced brain perfusion and cognitive performance due to constitutional hypotension". Clinical Autonomic Research 17 (2): 69–76. doi:10.1007/s10286-006-0379-7. PMC 1858602. PMID 17106628.

[ReferenceA-4] van Beek AH, Claassen JA, Rikkert MG, Jansen RW. Cerebral autoregulation: an overview of current concepts and methodology with special focus on the elderly. J Cereb Blood Flow Metab. 2008 Jun;28(6):1071-85

[Tolias_and_Sgouros-5] Tolias C and Sgouros S. 2003. "Initial Evaluation and Management of CNS Injury." Emedicine.com. Retrieved on March 19, 2007

[6] Czosnyka M, Pickard JD (2004). "Monitoring and interpretation of intracranial pressure". Journal of Neurology, Neurosurgery, and Psychiatry 75 (6): 813–821. doi:10.1136/jnnp.2003.033126. PMC 1739058. PMID 15145991.

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cerebral perfusion pressure