Chronic cerebrovascular dysfunction after traumatic brain injury

Abstract

Traumatic brain injuries (TBI) often involve vascular dysfunction that leads to long-term alterations in physiological and cognitive functions of the brain. Indeed, all the cells that form blood vessels and that are involved in maintaining their proper function can be altered by TBI. This Review focuses on the different types of cerebrovascular dysfunction that occur after TBI, including cerebral blood flow alterations, autoregulation impairments, subarachnoid hemorrhage, vasospasms, blood-brain barrier disruption, and edema formation. We also discuss the mechanisms that mediate these dysfunctions, focusing on the cellular components of cerebral blood vessels (endothelial cells, smooth muscle cells, astrocytes, pericytes, perivascular nerves) and their known and potential roles in the secondary injury cascade. © 2016 Wiley Periodicals, Inc.

Keywords: cerebrovascular dysfunction; neurovascular dysfunction; traumatic brain injury.

FIGURE 1. Morphology and characteristics of cerebral blood vessels

Cerebral blood vessels are formed by 3 distinct layers: the tunica intima with endothelial cells and a basement membrane; the tunica media with smooth muscle cells; and the tunica adventitia with collagen fibers, fibroblasts and associated cells like nerve fibers and astrocytes. Capillaries are formed with only a tunica intima with a basement membrane enclosing pericytes. (This figure was produced using Servier Medical Art; www.servier.com).