The Cerebral Circulation In Health And Disease

This e-book will review 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.

This text aims to provide the reader with a complete understanding of the anatomical, physiological and pharmacological bases of the cerebral circulation, its regulation in health and disease and the pathophysiological disturbances occurring in cerebrovascular disorders.

Modern brain imaging is revolutionizing the study of brain function in health and disease. However, few realize that its origins began in the nineteenth century with Dr. Angelo Mosso's pioneering experiments. A foremost Italian physiologist and scientist, Angelo Mosso studied several patients brought to him with head injuries that exposed their live brains to direct, long-term observation. He took advantage of these rare opportunities to document, for the first time, changes in cerebral blood flow in response to different stimuli, behaviors, and emotions, the very same changes that are now the basis for the measurements underlying modern functional brain imaging. Mosso was widely recognized by his contemporaries for his highly original studies, published both in Italian in 1878 and in German in 1881. Yet there has never been a translation through which this groundbreaking work could be appreciated by the English-speaking world. Indeed, Angelo Mosso's sophisticated experiments were to neuroscience what surgeon William Beaumont's in vivo observations were to gastric physiology fifty years earlier. This unique monograph establishes Mosso's rightful role as the pioneer of brain imaging. Through it, the modern reader, whether expert neuroscientist or interested student, can gain a new perspective on the author's remarkable insights: how behaviors as subtle as thinking about a subject or feeling an emotion produce the changes in pulsations of the brain that he observed and recorded for posterity. Special features of this volume include first a brief summary of Mosso's life. Two pioneers of modern brain imaging, Marcus E. Raichle (winner of the Kavli Prize for Neuroscience) and Gordon M. Shepherd (Yale University Professor of Neurobiology) then review Mosso's work and provide extensive commentary to explain its relevance to modern brain science. The authors not only emphasize Mosso's pioneering role in brain imaging, but also his fundamental contribution to the rise of cognitive neuroscience. The English translation (by historian of medicine Christiane Nockels Fabbri) follows, together with all of the plates and illustrations of the original volume. The result is a classic of neuroscience, now available for wide appreciation by neuroscientists, neurologists, psychologists, psychiatrists, historians of science and medicine, and the general public.

Core Topics in Neuroanesthesia and Neurointensive Care is an authoritative and practical clinical text that offers clear diagnostic and management guidance for a wide range of neuroanesthesia and neurocritical care problems. With coverage of every aspect of the discipline by outstanding world experts, this should be the first book to which practitioners turn for easily accessible and definitive advice. Initial sections cover relevant anatomy, physiology and pharmacology, intraoperative and critical care monitoring and neuroimaging. These are followed by detailed sections covering all aspects of neuroanesthesia and neurointensive care in both adult and pediatric patients. The final chapter discusses ethical and legal issues. Each chapter delivers a state-of-the art review of clinical practice, including outcome data when available. Enhanced throughout with numerous clinical photographs and line drawings, this practical and accessible text is key reading for trainee and consultant anesthetists and critical care specialists.

Unlike some other reproductions of classic texts (1) We have not used OCR(Optical Character Recognition), as this leads to bad quality books with introduced typos. (2) In books where there are images such as portraits, maps, sketches etc We have endeavoured to keep the quality of these images, so they represent accurately the original artefact. Although occasionally there may be certain imperfections with these old texts, we feel they deserve to be made available for future generations to enjoy.

Excerpt from On Disorders of the Cerebral Circulation: And on the Connection Between Affections of the Brain and Diseases of the Heart The present volume does not pretend to be a complete treatise on the subjects which are discussed in its successive sections. The mass of the materials of which it is composed formed the substance of the Lumleian Lectures delivered at the Royal College of Physicians in the months of February and March 1843 and 1844. The first series of Lectures was afterwards published in the London Medical Gazette (May 1843). The physiological and pathological doctrines advanced in those lectures attracted the attention, and subsequent favourable notice, of many whose opinions the author highly valued. About the Publisher Forgotten Books publishes hundreds of thousands of rare and classic books. Find more at www.forgottenbooks.com This book is a reproduction of an important historical work. Forgotten Books uses state-of-the-art technology to digitally reconstruct the work, preserving the original format whilst repairing imperfections present in the aged copy. In rare cases, an imperfection in the original, such as a blemish or missing page, may be replicated in our edition. We do, however, repair the vast majority of imperfections successfully; any imperfections that remain are intentionally left to preserve the state of such historical works.

Much of our knowledge of the cerebral circulation has been derived from studies of species other than human. There is increas ing recognition of species differences and concern that studies in animals may be misleading if unquestioningly applied to the human. A dramatic example of this occurred in the early his tory of the study of the circulation of the brain. Galen of Pergamo (131-201 AD) described a rete mirabile or "marvelous network" of blood vessels at the base of the human skull that he must have derived from observations of certain animals. This vascular structure was supplied by the carotid arteries which, after penetrating the cranium,"are divided into a large number of very small and thin branches in the region between the cranium and the dura matter. Then . . . intersecting one another they give the impression of having forgotten their way in the brain. But this is not the case. In fact, these numerous arteries rejoin and unite like the roots of a tree trunk. . . . " The authority of Galen's writings dominated scientific thought for about 1500 years. His description of a rete was unques tioned by Leonardo de Vinci, who included it in his anatomical sketches. William Harvey's remarkable observations led to his definitive account of the circulation of blood.