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From high altitude and space, extreme apnoea, heat and cold stress, the impact of these stressors on the regulation of cerebral blood flow (CBF) and oxygen metabolism () is discussed. As long as consciousness remains,  and oxygen delivery () remain stable during acute and chronic exposure to poikilocapnic hypoxia. Such a response is possible with alterations in CBF to maintain a relatively stable . Likewise, the elevations in CBF during exercise in conditions of acute and chronic hypoxia seem to be appropriate to maintain stable . In freedivers, prolonged periods of apnoea during breath\u2010hold reflect marked hypoxaemia and acidosis. At these extremes in elite human freedivers, although elevations in CBF seem to maintain , there is evidence of reductions in . In contrast to hypoxia, heat\u2010 or cold\u2010induced hyperventilation and related hypocapnic\u2010induced vasoconstriction, marked reductions in CBF and  can occur. In the cold, however, the reductions in CBF seem to be partly compensated by elevations in blood pressure and haemoconcentration. In the heat,\n                    <jats:italic>Q<\/jats:italic>\n                    <jats:sub>10<\/jats:sub>\n                    \u2010mediated elevations in  are challenged by cerebral vasoconstriction and limited , especially when hyperventilation is pronounced. Furthermore, intracranial velocity seems stable during spaceflight despite elevations in . The implications of these changes in CBF and metabolism during environmental stressors are considered in the context of neuropsychological functioning. Finally, the limited research on cross\u2010exposures on cerebrovascular function is reviewed, and future research directions are proposed.\n                  <\/jats:p>","DOI":"10.1113\/ep093359","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T14:58:30Z","timestamp":1772981910000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Brain strain: Blood flow and metabolism in environmental extremes"],"prefix":"10.1113","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1259-6230","authenticated-orcid":false,"given":"Dario","family":"Vrdoljak","sequence":"first","affiliation":[{"name":"Centre for Heart, Lung and Vascular Health University of British Columbia, Okanagan Campus  Kelowna British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0498-7095","authenticated-orcid":false,"given":"Damian M.","family":"Bailey","sequence":"additional","affiliation":[{"name":"Neurovascular Research Laboratory, Faculty of Life Sciences and Education University of South Wales  Pontypridd UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3893-9948","authenticated-orcid":false,"given":"Travis D.","family":"Gibbons","sequence":"additional","affiliation":[{"name":"Department of Biological Sciences Northern Arizona University  Flagstaff Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip N.","family":"Ainslie","sequence":"additional","affiliation":[{"name":"Centre for Heart, Lung and Vascular Health University of British Columbia, Okanagan Campus  Kelowna British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpregu.91008.2008"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00854.2014"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1113\/EP085671"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.01385.2003"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1042\/CS20130343"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1089\/ham.2013.1138"},{"issue":"1","key":"e_1_2_11_8_1","first-page":"21","article-title":"Arterial oxygen desaturation during apnea in humans","volume":"25","author":"Andersson J.","year":"1998","journal-title":"Undersea & Hyperbaric Medicine"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.01057.2002"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/sms.13573"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1507581"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s004210100473"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00231.2021"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature09613"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004647-200110000-00001"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)32393-5"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/j.1552-4604.1991.tb03668.x"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1113\/EP092629"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1177\/0271678X221075967"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41526-025-00537-1"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroscience.2020.05.048"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1177\/0271678X16686093"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1113\/JP272404"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1096\/fj.201701031R"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1515\/tnsci-2016-0003"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1113\/EP086269"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpregu.00271.2015"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1113\/JP278889"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2014.00092"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/cphy.c140066"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00394.2013"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1681.2005.04289.x"},{"key":"e_1_2_11_33_1","volume-title":"The brain at high altitude","author":"Baumgartner R. 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