The effect of lesion volume on cerebral vasomotor tone after focal brain injury and shock.

We have previously shown that the volume of a focal brain injury influences cerebral blood flow. We hypothesized that the cerebral vasomotor tone after traumatic brain injury and shock is related to lesion volume and that the size of the lesion would affect vasomotor reactivity. Swine were randomized to receive either a large or small cryogenic injury followed by shock, and were studied for 5 h postresuscitation. A small brain injury and shock produced a significant and sustained increase in bihemispheric pial arteriolar diameter when compared to the large lesion group and controls. A large brain injury and shock resulted in a significant decrease in the pial arteriolar diameter in the injured hemisphere. We also noted significant differences between and within groups in interhemispheric pial arteriolar diameter and pial arteriolar reactivity to acetylcholine and hypocarbia. These data suggest that the volume of injured tissue influences cerebral blood flow by a vascular mechanism, which may be due in part to an alteration in cerebral endothelial cell function.