脳血管障害と自律神経障害

Cerebrovascular Diseases and Autonomic Failure

脳血管には自律神経として交感神経と副交感神経が分布しており，三叉神経による逆行性伝導とともに脳血流を調整している。脳血管の神経性調節は，脳機能が活性化した際に血流増加をもたらすカップリング機構，血圧変動に対する血流の自動調節能など生理機能に関わる。また血管狭窄病変の末梢で生じる血管の拡張，血行再建時の過灌流，可逆性脳血管攣縮症候群，片頭痛など，さまざまな疾患の病態に関わる。

Abstract

Cerebral vessels are innervated by sympathetic and parasympathetic nerves, as well as the trigeminal nerve. Under physiological conditions, neural regulation contributes to coupling of cerebral blood flow (CBF) and metabolism and autoregulation of CBF against systemic blood pressure. It also plays a key role in vasodilatation distal to narrowed vascular lesions associated with atherosclerosis, hyperperfusion syndrome that occurs after vascular reconstruction in patients with chronic ischemic diseases, reversible cerebral vasoconstriction syndrome, and migraine. Moreover, cerebrovascular disease can cause autonomic dysfunction; frontal lobe and brain stem lesions are known to result in urinary incontinence, mydriasis, and Horner's syndrome.