Impairment of Cerebral Blood Flow Regulation in Astronauts With Orthostatic Intolerance After Flight

Background and Purpose-We investigated cerebral blood flow regulation in astronauts before and after flights. We hypothesized that autoregulation would be different before flight and after flight between nonfinishers and the finishers of a stand test. Methods-Twenty-seven astronauts from shuttle missions lasting 8 to 16 days underwent a 10-minute stand test: 10 days before flight, 1 to 2 hours and 3 days after landing. Mean blood flow velocity of the middle cerebral artery (MCA) was measured using transcranial Doppler; Mean arterial pressure was measured using a Finapres (Ohmeda, Englewood, CO) and was adjusted to the level of the MCA (BPMCA). Cross-spectral power, gain, phase, and coherence were determined for the relation between BPMCA and the cerebrovascular resistance index mean blood flow velocity/BPMCA. Results-BPMCA was reduced with stand (P < 0.001). Differences between finishers and nonfinishers (P = 0.011) and over test days (P = 0.004) were observed. Cerebrovascular conductance was affected by stand (P < 0.001), by group (P < 0.001) with a group by stand, and test day interaction (P < 0.01). Preflight data suggest that the nonfinishers were operating at a higher cerebral vasodilation than finishers for a given BPMCA, and on landing day the nonfinishers had a greater decrease in mean blood flow velocity as a function of BPMCA with standing compared to finishers and preflight. There was a significant interaction effect of gender over the test days and from supine to stand (P = 0.035). Conclusions-Our results indicate that the cause of presyncope in astronauts may be related to a mismatch of cerebral blood flow with blood pressure. Astronaut gender may also play a role in susceptibility to orthostatic intolerance after flight. (Stroke. 2011; 42: 1844-1850.)