This scoping review delves into the complex relationship between cerebral autoregulation, the brain’s mechanism to maintain stable blood flow despite changes in blood pressure, and spreading depolarization (SD) events, which are critical in the context of brain ischemia. It highlights the challenge in directly measuring cerebral autoregulation due to the need for indirect methods that rely on assumptions. The review emphasizes the risk of brain ischemia in patients with impaired cerebral autoregulation, particularly through the lens of SD events that can lead to terminal depolarization. By examining various methods to measure cerebral autoregulation, their theoretical advantages and limitations, and the clinical evidence supporting their use, the review aims to shed light on the potential link between impaired autoregulation and SD occurrences. This understanding could pave the way for personalized treatments by offering insights into an individual’s specific physiological conditions. The significance of this review lies in its potential to enhance our understanding of cerebral autoregulation’s role in brain ischemia and to identify targeted therapeutic strategies.