Table 1 Pathophysiology of Cerebral Misery Perfusion (Stage 1 to 3 Cerebral Haemodynamic Impairment)
Stage 1 (Cerebrovascular autoregulation) | Any fall in regional cerebral perfusion pressure (rCPP) is matched by a fall in regional cerebrovascular resistance (rCBR) in order to maintain regional cerebral blood flow (rCBF). This is accommodated by vasodilatation and an attendant increase in regional cerebral blood volume (rCBV). Oxygen extraction factor (OEF) remains constant. |
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Stage 2 (Misery Perfusion) | The capacity for compensatory vasodilatation is exceeded (rCVR becomes a constant) and rCBF therefore drops in tandem with rCPP. To meet their metabolic demands, neurones must "extract more oxygen" from the passing blood - OEF increases. |
Stage 3 (End-organ compromise) | If rCBF continues to fall to the extent that the brain can no longer compensate by increases in OEF, end-organ dysfunction occurs (TIA). If this situation persists, permanent end-organ damage (stroke) occurs. |