title: Hemodynamic changes in the posterior cerebral circulation triggered by insufficient sympathetic innervation--cause of primary intracerebral hemorrhage?
abstract: Primary intracerebral hemorrhage (ICH) is caused by hypertensive disease of small penetrating blood vessels in the basal ganglia, brain stem and cerebellum. Those regions are supplied by arteries of the so-called posterior brain circulation with insufficient sympathetic innervation. We propose the following hypothesis: due to insufficient sympathetic innervation hemodynamic changes occur in the vascular bed of the posterior brain circulation serving as a key factor for arterial rupture. If autoregulation is insufficient to maintain normal cerebral blood flow, in abrupt rise in the blood pressure, the amount of blood is rising causing higher static pressure, and according to Laplace's law higher pressure and larger radius leads to higher wall tension and subsequent rupture of arterial wall previously weakened by prolonged hypertension.
authors.affiliation: Intensive Care Unit, Department of Neurology, University Hospital Rijeka, Cambierieva 17, Rijeka, Croatia. sinisa.dunatov@ri.t-com.hr
authors.forename: Sinisa
authors.initials: S
authors.lastname: Dunatov
authors.forename: Igor
authors.initials: I
authors.lastname: Antoncic
authors.forename: Marina
authors.initials: M
authors.lastname: Bralic
mesh_terms: D001703:Biophysics / Q000379:methods; D001794:Blood Pressure; D001921:Brain / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000503:physiopathology*; D002560:Cerebrovascular Circulation; D004487:Edema; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension; D007700:Kinetics; D008833:Microcirculation; D008954:Models, Biological; D008962:Models, Theoretical; D013564:Sympathetic Nervous System