Effect of optode separation on brain penetration in adults

Cerebral Autoregulation and Syncope

Whatever the pathogenesis of syncope is, the ultimate common cause leading to loss of consciousness is insufficient cerebral perfusion with a critical reduction of blood flow to the reticular activating system. Brain circulation has an autoregulation system that keeps cerebral blood flow constant over a wide range of systemic blood pressures. Normally, if blood pressure decreases, autoregulation reacts with a reduction in cerebral vascular resistance, in an attempt to prevent cerebral hypoperfusion. However, in some cases, particularly in neurally mediated syncope, it can also be harmful, being actively implicated in a paradox reflex that induces an increase in cerebrovascular resistance and contributes to the critical reduction of cerebral blood flow. This review outlines the anatomic structures involved in cerebral autoregulation, its mechanisms, in normal and pathologic conditions, and the noninvasive neuroimaging techniques used in the study of cerebral circulation and autoregulation. An emphasis is placed on the description of autoregulation pathophysiology in orthostatic and neurally mediated syncope.

Syncope, cerebral perfusion, and oxygenation

During standing, both the position of the cerebral circulation and the reductions in mean arterial pressure (MAP) and cardiac output challenge cerebral autoregulatory (CA) mechanisms. Syncope is most often associated with the upright position and can be provoked by any condition that jeopardizes cerebral blood flow (CBF) and regional cerebral tissue oxygenation (cO(2)Hb). Reflex (vasovagal) responses, cardiac arrhythmias, and autonomic failure are common causes. An important defense against a critical reduction in the central blood volume is that of muscle activity ("the muscle pump"), and if it is not applied even normal humans faint. Continuous tracking of CBF by transcranial Doppler-determined cerebral blood velocity (V(mean)) and near-infrared spectroscopy-determined cO(2)Hb contribute to understanding the cerebrovascular adjustments to postural stress; e.g., MAP does not necessarily reflect the cerebrovascular phenomena associated with (pre)syncope. CA may be interpreted as a frequency-dependent phenomenon with attenuated transfer of oscillations in MAP to V(mean) at low frequencies. The clinical implication is that CA does not respond to rapid changes in MAP; e.g., there is a transient fall in V(mean) on standing up and therefore a feeling of lightheadedness that even healthy humans sometimes experience. In subjects with recurrent vasovagal syncope, dynamic CA seems not different from that of healthy controls even during the last minutes before the syncope. Redistribution of cardiac output may affect cerebral perfusion by increased cerebral vascular resistance, supporting the view that cerebral perfusion depends on arterial inflow pressure provided that there is a sufficient cardiac output.

Quantitative evaluation of the relative contribution ratio of cerebral tissue to near-infrared signals in the adult human head: a preliminary study

Combining spatially- and time-resolved spectroscopies. we attempted to quantitatively evaluate the contribution ratio of the partial mean pathlength of cerebral tissue to the observed overall mean pathlength, in which haemoglobin concentrations were selectively changed by administration of acetazolamide. When acetazolamide was administered, the observed increases in oxygenated haemoglobin depended on the probe distance, which became progressively larger at distances of 2, 3 and 4 cm. Increases in oxygen saturation were detected at 3 and 4 cm spacing, but not at 2 cm. Assuming that the modified Lambert-Beer's law can exist in the inhomogeneous structure of the head, then, we could estimate the contribution ratio of the cerebral tissue to optical signals at the probe distances of 2, 3 and 4 cm as 33%, 55% and 69%, respectively. Using these values, we recalculated acetazolamide-induced concentration changes in oxygenated-haemoglobin in the cerebral tissue, which resulted in the same values at distances of 2, 3 and 4 cm as expected. Thus, our present method opened the door to the possibility of selectively obtaining optical signals attributed to cerebral tissue.

The calibration and validation of a phase-modulated near-infrared cerebral oximeter

OBJECTIVE

This study was undertaken to compare the cerebral oxygenation measured by an experimental phase-modulated near-infrared (NIR) spectroscopy system with capillary saturation estimated from jugular venous oxygen saturation.

METHODS

Jugular venous catheters were placed in 30 patients undergoing carotid endarterectomy and 194 measurements of venous oxygen saturation were obtained intra operatively. Simultaneous measurement of optical path length at 754, 785, and 816 nm was performed using a phase-modulated near-infrared spectroscopy system. Optical calibration was performed using both an optical bench and a scattering mold. Hemoglobin saturation was calculated from NIR measurements using equations derived from diffusion theory. Capillary saturation was calculated from the arterial and venous saturations.

RESULTS

Jugular venous saturations ranged from 41 to 92%. When calibrated using the optical bench, the NIR estimates of hemoglobin saturation deviated from estimated capillary values by an average of 2.6% bias and 4.3% deviation. No systematic bias was noted. NIR values derived from mold calibration were less accurate and precise (4.6% bias and 6.9% deviation.) Use of the initial venous sample as an in vivo calibration improved the accuracy of the mold calibration but did not alter the performance of the bench calibration.

CONCLUSIONS

Under the conditions tested, an experimental phase-modulated near-infrared spectroscopy system calibrated using an optical bench agreed with capillary saturation estimated from jugular venous samples. Further work is necessary to demonstrate valid performance of the system under other conditions.