A hipertensão arterial é uma doença que aflinge mais de um quarto da população adulta mundial e mais da metade da população idosa. Ela é o principal fator de risco para doenças cerebrovasculares e o segundo fator de risco, após idade, para os acidentes vasculares cerebrais (AVC) hemorrágico e isquêmico. É também a principal causa de declínio cognitivo e demência, incluindo a doença de Alzheimer. A hipertensão causa remodelamento vascular e modifica os mecanismos de regulação do fluxo sangüíneo cerebral, incluindo a hiperemia funcional, a autoregulação cerebrovascular e a regulação endotelial. Portanto, pesquisas contínuas sobre os efeitos da hipertensão na função cerebrovascular são cruciais para o desenvolvimento de terapias preventivas que objetivam minimizar os riscos de desenvolvimento de doenças cerebrovasculares. No presente estudo, a perfusão cerebral de um importante modelo experimental de hipertensão, o rato SHR (do inglês spontaneously hypertensive rat), foi avaliada utilizando as técnicas de arterial spin labeling (ASL), que permitem a quantificação não-invasiva da perfusão. Utilizando o método de ASL contínua, o fluxo sangüíneo cerebral foi quantificado para todo o cérebro do rato sob condições de normocapnia e hipercapnia. Resistência cerebrovascular aumentada e reatividade vascular ao CO2 reduzida foram observadas em SHR adultos, confirmando que a hipertensão leva à redução progressiva da capacidade de dilatação da vasculatura cerebral. A técnica de ASL dinâmica permitiu medir o fluxo sangüíneo cerebral funcional evocado por estimulação somatosensorial. Além de apresentarem resposta hemodinâmica positiva à estimulação, os ratos hipertensos também apresentaram resposta hemodinâmica negativa em áreas circundantes àquelas ativadas positivamente. Foi mostrado que esse resultado está relacionado com um efeito puramente hemodinâmico causado pela pressão arterial elevada e pela reserva vascular alterada do SHR. Experimentos farmacológicos mostraram diferenças na modulação do acoplamento neurovascular de SHR quando comparado com rato normotenso. Além disso, SHR submetidos à oclusão temporária da artéria cerebral média apresentaram maior volume da lesão isquêmica e do edema cerebral, redução severa da massa corporal e déficits neurológicos piores do que ratos normotensos. Esses resultados estão relacionados à autoregulação cerebral alterada e ao desenvolvimento prejudicado da circulação colateral em SHR. Em suma, os achados do presente estudo mostraram que a hipertensão resulta em reserva vascular prejudicada, acoplamento neurovascular alterado e piores conseqüências a um AVC isquêmico. / Hypertension is a disease that afflicts more than a quarter of the general population and more than half of the elderly population. It is the most important modifiable risk factor for cerebrovascular diseases and the second most important risk factor, after age, for hemorrhagic and ischemic stroke. It is a leading cause of cognitive decline and dementia, including the Alzheimer\'s disease. Hypertension causes vascular remodeling and modifies the intricate mechanisms of cerebral blood flow (CBF) regulation, including functional hyperemia, cerebrovascular autoregulation, and endothelial regulation. For all of the above, continued research on the effects of hypertension on cerebrovascular function is a crucial step in the design of preventive therapies aimed at minimizing the risk of development of cerebrovascular disease. In the present work, cerebral perfusion of an important experimental model of hypertension, the spontaneously hypertensive rat (SHR), was evaluated using the arterial spin labeling (ASL) techniques, which allow non-invasive quantification of perfusion. Using continuous ASL, CBF was quantified for the whole rat brain under normocapnic and hypercapnic conditions. Increased cerebrovascular resistance and decreased vascular reactivity to CO2 were observed in adult SHR, confirming that hypertension leads to reduced compliance of the cerebral vasculature. The dynamic ASL technique allowed the measurement of functional CBF evoked by somatosensorial stimulation. Hypertensive rats not only showed positive hemodynamic response to stimulation, but also negative hemodynamic response in areas surrounding the positively activated areas. It was shown to be related to a purely hemodynamic effect caused by high blood pressure and impaired vascular reserve of the SHR. Pharmacological experiments showed differences on modulation of the neurovascular coupling in SHR when compared to normotensive rats. Moreover, hypertensive rats subjected to temporary middle cerebral artery occlusion had larger ischemic lesion volume and brain edema, severe decrease in body weight and worse neurological deficits, when compared to normotensive rats. These results are related to the altered cerebral autoregulation and impaired collateral circulation development in SHR. Taken together, the findings of the present work show that hypertension results in impaired vascular reserve, which is related to altered neurovascular coupling and worse stroke outcome.

Normal pressure hydrocephalus (NPH), a CSF circulation disorder, is important as a reversible cause of gait and cognitive disturbance in an aging population. The inconsistent response to CSF shunting is usually attributed to difficulties in differential diagnosis or co-morbidity. Improving outcome depends on an increased understanding of the pathophysiology of NPH. Specifically, this thesis examines the contribution of, and inter-relationship between, the brain parenchyma and CSF circulation in the pathophysiology of NPH. Of the four core studies of the thesis, the first quantifies the characteristics of the CSF circulation and parenchyma in NPH using CSF infusion studies to measure the resistance to CSF absorption and brain compliance. The second study assesses cerebral blood flow (CBF) was using O15-labelled positron emission tomography (PET) with MR co-registration. By performing CSF infusion studies in the PET scanner, CBF at baseline CSF pressure and at a higher equilibrium pressure is measured. Regional changes and autoregulatory capacity are assessed. The final study examines the microstructural integrity of the parenchyma using MR diffusion tensor imaging. These studies confirm the importance of the inter-relationship of the brain parenchyma and CSF circulation. NPH symptomatology and its relationship to the observed regional CBF reductions in the basal ganglia and thalamus are discussed. Regional CBF reductions with increased CSF pressure and the implications for autoregulatory capacity in NPH are considered. The reduction in CBF when CSF was increased was most striking in the periventricular regions. In addition, periventricular structures demonstrated increased diffusivity and decreased anisotropy. The relationship between these changes and mechanisms such as transependymal CSF passage are reviewed. The findings of this thesis support a role of both the CSF circulation and the brain parenchyma in the pathophysiology of NPH. The results have implications for the approach to the management of patients with NPH.

The current work investigated the stimulation induced spatial response of the cerebral microvascular network by reconstruction of the 3D microvascular morphology from in vivo two photon fluorescence microscopy (2PFM) volumes using an automated, model based tracking algorithm. In vivo 2PFM imaging of the vasculature in the forelimb representation of the primary somatosensory cortex of alpha-chloralose anesthetized rats was achieved via implantation of a closed cranial window, and intravascular injection of fluorescent dextran. The dilatory and constrictory responses of the cerebral microvascular network to functional stimulation were heterogeneous and depended on resting vascular radius and response latency. Capillaries experienced large relative dilations and constrictions, but the larger vessel absolute volume changes dominated the overall network cerebral blood volume change.

This thesis investigated the role of CBF assessment in the management of stroke in children with sickle cell disease (SCD). It is divided into two parts. In the first part, a systematic review of CBF assessment using different imaging modalities in SCD children was designed. The prevalence of CBF abnormalities was found to be equal to or higher than those of structural MRI and transcranial Doppler (TCD) in SCD children who have not experienced stroke. Studies reviewed suggested CBF assessment in SCD could aid in addressing brain abnormalities at the tissue level. In the second part, the arterial spin labeling (ASL) technique was used to depict CBF abnormalities in SCD children. ASL demonstrated perfusion abnormalities that seem to remain invisible in TCD measurements; CBF interhemispheric asymmetries were associated with clinically silent infarctions with no corresponding flow velocity interhemispheric asymmetries assessed with TCD.

The current work investigated the stimulation induced spatial response of the cerebral microvascular network by reconstruction of the 3D microvascular morphology from in vivo two photon fluorescence microscopy (2PFM) volumes using an automated, model based tracking algorithm. In vivo 2PFM imaging of the vasculature in the forelimb representation of the primary somatosensory cortex of alpha-chloralose anesthetized rats was achieved via implantation of a closed cranial window, and intravascular injection of fluorescent dextran. The dilatory and constrictory responses of the cerebral microvascular network to functional stimulation were heterogeneous and depended on resting vascular radius and response latency. Capillaries experienced large relative dilations and constrictions, but the larger vessel absolute volume changes dominated the overall network cerebral blood volume change.

This thesis investigated the role of CBF assessment in the management of stroke in children with sickle cell disease (SCD). It is divided into two parts. In the first part, a systematic review of CBF assessment using different imaging modalities in SCD children was designed. The prevalence of CBF abnormalities was found to be equal to or higher than those of structural MRI and transcranial Doppler (TCD) in SCD children who have not experienced stroke. Studies reviewed suggested CBF assessment in SCD could aid in addressing brain abnormalities at the tissue level. In the second part, the arterial spin labeling (ASL) technique was used to depict CBF abnormalities in SCD children. ASL demonstrated perfusion abnormalities that seem to remain invisible in TCD measurements; CBF interhemispheric asymmetries were associated with clinically silent infarctions with no corresponding flow velocity interhemispheric asymmetries assessed with TCD.

An age-related decline in cerebral blood flow (CBF) is widely acknowledged. However, uncertainty exists as to whether this reduction is the result of a reduced metabolic demand (cerebral atrophy) or an impaired delivery system (cerebrovascular disease). The purpose of these experiments was to examine the relationship of CBF and dynamic cerebrovascular regulation with changes in common carotid intima-media thickness (cIMT), brachial-ankle pulse wave velocity (baPWV) and common carotid distensibility. Additionally, we took an exploratory view into the effect of vascular aging and CBF reduction on brain function, as expressed through the performance of motor and cognitive tasks. An important finding in elderly participants was that seated anterior CBF declined as a function of arterial stiffness, independently of age. Linear regression analysis developed a model that predicts CBF drops 22 ml/min (95% confidence interval (CI): 6, 38) for each 100 cm/s increase in baPWV and 8 ml/min (95% CI: 1, 15) for each additional year in age. The effect of baPWV appears to be mediated through an increase in cerebrovascular resistance (r2 = 0.84, p < 0.0001). Additionally, CBF showed postural dependency and the volume of the drop in CBF between supine and seated positions was greatest in elderly participants (YOUNG: 65 ± 81 ml/min; ELDERLY: 155 ± 119 ml/min; p = 0.001). Despite this negative impact of vascular aging on steady state flow, dynamic regulation does not appear to be affected. Cerebrovascular responses to an acute drop in blood pressure or to activation of the motor cortex were not attenuated in the elderly participants. Finally, seated CBF had modest directionally relevant relationships with perceptuo-motor and complex sequencing processes; while cIMT appeared to influence performance on initiation and inhibition tasks.

An age-related decline in cerebral blood flow (CBF) is widely acknowledged. However, uncertainty exists as to whether this reduction is the result of a reduced metabolic demand (cerebral atrophy) or an impaired delivery system (cerebrovascular disease). The purpose of these experiments was to examine the relationship of CBF and dynamic cerebrovascular regulation with changes in common carotid intima-media thickness (cIMT), brachial-ankle pulse wave velocity (baPWV) and common carotid distensibility. Additionally, we took an exploratory view into the effect of vascular aging and CBF reduction on brain function, as expressed through the performance of motor and cognitive tasks. An important finding in elderly participants was that seated anterior CBF declined as a function of arterial stiffness, independently of age. Linear regression analysis developed a model that predicts CBF drops 22 ml/min (95% confidence interval (CI): 6, 38) for each 100 cm/s increase in baPWV and 8 ml/min (95% CI: 1, 15) for each additional year in age. The effect of baPWV appears to be mediated through an increase in cerebrovascular resistance (r2 = 0.84, p < 0.0001). Additionally, CBF showed postural dependency and the volume of the drop in CBF between supine and seated positions was greatest in elderly participants (YOUNG: 65 ± 81 ml/min; ELDERLY: 155 ± 119 ml/min; p = 0.001). Despite this negative impact of vascular aging on steady state flow, dynamic regulation does not appear to be affected. Cerebrovascular responses to an acute drop in blood pressure or to activation of the motor cortex were not attenuated in the elderly participants. Finally, seated CBF had modest directionally relevant relationships with perceptuo-motor and complex sequencing processes; while cIMT appeared to influence performance on initiation and inhibition tasks.

Changes in cerebrovascular reactivity (CVR) to carbon dioxide (CO2) are reported in many neurological conditions. My aim was to validate a method for computerized prospective targeting of CO2 levels (RespiractTM) as a bedside tool for impaired CVR. I hypothesized that 1) The RespiractTM and TCD method can be used to detect impairment of CVR after SAH and that 2) CVR is impaired in SAH patients. In 18 SAH patients and 26 controls CVR index was calculated dividing the percentage change in middle cerebral artery blood flow velocity (MCAv) by the change in PETCO2. The absolute MCAv values were similar in both groups, but CVR was significantly different (hypercapnia: 0.044 ± 0.076 - controls; 0.014 ± 0.037 - SAH; p=0.0007). I showed that impaired CVR can be detected at the bedside using TCD and CO2 challenge with the RespiractTM, control of CO2 is precise and minimal changes are required.

Changes in cerebrovascular reactivity (CVR) to carbon dioxide (CO2) are reported in many neurological conditions. My aim was to validate a method for computerized prospective targeting of CO2 levels (RespiractTM) as a bedside tool for impaired CVR. I hypothesized that 1) The RespiractTM and TCD method can be used to detect impairment of CVR after SAH and that 2) CVR is impaired in SAH patients. In 18 SAH patients and 26 controls CVR index was calculated dividing the percentage change in middle cerebral artery blood flow velocity (MCAv) by the change in PETCO2. The absolute MCAv values were similar in both groups, but CVR was significantly different (hypercapnia: 0.044 ± 0.076 - controls; 0.014 ± 0.037 - SAH; p=0.0007). I showed that impaired CVR can be detected at the bedside using TCD and CO2 challenge with the RespiractTM, control of CO2 is precise and minimal changes are required.