This book reviews 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.
Table of Contents
Anatomy and Ultrastructure
Regulation of Cerebrovascular Tone
Control of Cerebral Blood Flow
Barriers of the CNS
About the Author(s)Marilyn J. Cipolla
, University of Vermont College of Medicine
Dr. Cipolla is Professor in the Department of Neurological Sciences and has joint appointments in Obstetrics, Gynecology, & Reproductive Science, and Pharmacology at the University of Vermont. She received her B.S. in Electrical Engineering in 1988 from the University of Vermont and her M.S. in Cell and Molecular Biology in 1994, then went on to obtain her Ph.D. in the same program in 1997. Her current research is focused on cerebral hemodynamics and blood-brain barrier function under normal and pathologic conditions including ischemic stroke and eclampsia. Dr. Cipolla is on the Editorial Boards of Stroke, Hypertension, translational Stroke research, and Frontiers in Physiology and has published over 100 peer-reviewed articles. She has been a member of the NINDS Stroke Progress Review Group and the Stroke Planning Workgroup, and is an advisor to the WHO Maternal and Childhood branch. Dr. Cipolla is a Fellow and Established Investigator of the AHA and is the past President of the Perinatal Research Society. She has received a number of awards, including the President's Achievement Award from the Society for Gynecologic Investigation and the Georgio Pardi Award. In 2015, she was named University Scholar by the University of Vermont. Dr. Cipolla has been continuously funded by the NIH since 1997 and has received grants from the AHA and the Pre-eclampsia Foundation.
The Cerebral Circulation has been an excellent source of information on the structure and function of blood vessels of the brain for graduate students, medical student, scientists and even for individuals without scientific background. The brain is a special organ that needs constant blood flow for proper function. Vessels play a key role in regulation of the blood flow to deliver nutrients and remove the waste. This book provides concise and up to date information that covers the basic specifics of how blood vessels of the brain work.
This book is also a good resource for basic understanding of the neurovascular unit that comprises of blood vessels, neighboring astrocytes and adjacent neurons. It succinctly summarizes the bidirectional communication within this unit. The section on blood brain barrier is brief but again provides the basics for readers to build upon. The second edition includes new data regarding regional differences in blood vessel function in the brain. Specifically, the comparison of pial surface vessels with penetrating and deep parenchymal arterioles is very informative. New section on pericytes provides a good understanding of the controversies in the field.
This short book is a perfect reference for people who want to understand how brain gets the blood it needs and how it keeps dangerous molecules away from its borders. Adviye Ergul - Medical College of Georgia
This is a great little volume that provides an up to date and concise description of the anatomical and functional bases of the cerebral circulation, from an expert in the field. Cerebrovascular physiology is an area of great interest for its implications in functional brain imaging and for brain pathology, e.g., stroke and dementia. However, up to date books on the subject are hard to find, and, to my knowledge, the last authoritative book dedicated to this topic was published in 2002 (Edvinsson and Krause, Cerebral Blood Flow and Metabolism, Lippincott). In the meantime, much progress has been made in the field. Therefore, Dr. Cipolla’s book is definitively the place to go for a comprehensive oveview of the cerebral circulation and would be a valuable source of information for those interested in cerebrovascular physiology and pathophysiology. The extensive number of recent references provides a useful source for those seeking more information. Definitely a keeper!
Costantino Iadecola, Cornell Medical School
The brain has a constant need for oxygen, glucose and other essential nutrients. To provide adequate spatial and temporal delivery of these molecules, a complex circulation is present, one that exceeds many other organs in relation to its level of regulation and cell-to-cell integration. In The Cerebral Circulation (second edition), Dr. Marilyn Cipolla presents an update to her successful and well-cited monograph dealing with this fascinating and clinically essential topic.
The text for the second edition is organized into five major sections, supported by over 20 figures and almost 250 references. Many of these have been updated since the first edition. Thus, the presentation provides an up-to-date synthesis of work in this area. Major sections include vascular anatomy (large blood vessels and the microcirculation), including the venous system. There is considerable discussion on the role of neurons and their impact on the vasculature via both extrinsic and intrinsic innervation. Other fundamental aspects of regulation of cerebral vascular resistance and thus blood flow – myogenic tone, myogenic responses, and endothelial based mechanisms are highlighted. The discussion considers how these various mechanisms are then integrated to impact segmental vascular resistance and cerebral blood flow through major underlying processes that include autoregulation, neurovascular coupling (known to some as functional hyperemia), and chemoregulation (responses to oxygen, carbon dioxide, and pH). The presentation ends with sections on essential barriers within the brain, the blood-brain barrier and the blood-cerebrospinal fluid barrier. This portion of the text highlights new insight into the role of various tight and junctional proteins, molecular transporters, and issues related to brain and cellular edema. Along the way, new topics of interest have been integrated including the potential impact of pericytes in the distal microcirculation and the importance of collateral vessels.
This edition of The Cerebral Circulation will be on interest to both basic and clinical researchers interested in the regulation of cerebral blood flow as well as large and small vessel disease and their implications for brain health and disease. The presentation is mechanistic and up-to-date. With so many specialized reviews appearing in the literature these days, a summary like this that gives a broad, but still fairly detailed overview of the cerebral circulation can be a valuable resource. Frank M. Faraci, PhD - University of Iowa College of Medicine