Pathobiology of Cerebral Blood Flow in Neurocritical Patients: The Central Nervous System Ischemic Response and Cushing's Triad as a New Concept, The Cerebral Pressure Dynamics Reactions

Cerebral blood flow (CBF) is the percentage of blood that supplies brain tissue and is essential for maintaining cerebral homeostasis due to the brain's significant metabolic demands. CBF is primarily regulated through cerebral autoregulation, which encompasses neurovascular mechanisms interrelated with levels of arterial gases. However, its dynamics are subject to constant changes, influenced by both physiological processes—such as aging and exercise—and pathological conditions, including neurodegenerative diseases and chronic illnesses. We introduce the new concept of "Cerebral Pressure Dynamics Reactions," which elucidates the interplay between the central nervous system's ischemic response and Cushing's triad. We propose that these responses represent a crucial adaptive mechanism to fluctuations in cerebral perfusion, highlighting their significance in the pathobiology of cerebral blood flow in neurocritical patients. Understanding these interactions may offer novel insights into therapeutic strategies to optimize CBF and improve outcomes in this vulnerable population.