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Updated: Jun 6, 2026

Integrated Compensatory Responses in a Human Model of Hemorrhage
Published on: November 20, 2016
Revisiting normal perfusion pressure breakthrough in light of hemorrhage-induced vasospasm
Matthew D Alexander1, E Sander Connolly, Philip M Meyers
1Matthew D Alexander, Department of Diagnostic Imaging, Santa Clara Valley Medical Center, San Jose, CA 95128, United States.
Abstract:
Cerebral arteriovenous malformations (AVMs) have abnormally enlarged arteries and veins prone to spontaneous hemorrhage. Immediately following surgical excision of a cerebral AVM, even normal brain tissue surrounding the lesion is subject to hemorrhage, a phenomenon termed normal perfusion pressure breakthrough (NPPB) syndrome. According to this theory, arteries supplying cerebral AVMs become dilated and lose their capacity to dilate or constrict to autoregulate pressure. Acutely after removal of a cerebral AVM, excessive blood pressure in these arterial feeders can cause normal brain tissue to bleed. However, this theory remains controversial. We present a patient with a cerebral AVM that demonstrated cerebrovascular reactivity and argues against an assumption underlying the theory of NPPB syndrome.
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