Blood-Brain Barrier Permeability Assessed by Perfusion CT Predicts Symptomatic Hemorrhagic Transformation and Malignant Edema in Acute Ischemic Stroke

Hom, Jason; Dankbaar, Jan Willem; Soares, Bruno P.; Schneider, Thomas; Cheng, Su–Chun; Bredno, Joerg; Lau, Benison C.; Smith, Wade S.; Dillon, William P.; Wintermark, Max

doi:10.3174/ajnr.a2244

Cited by 145 publications

(114 citation statements)

References 41 publications

Supporting

Mentioning

102

Contrasting

Unclassified

Order By: Relevance

“…Computed tomography has the advantage over MRI in that the studies can be performed more rapidly, allowing measurements to be made in acute stroke before treatment with tPA (tissue plasminogen activator). In one study, CT showed disruption of the BBB in the early stages of stroke, which was proposed as an aid in deciding when it was safe to give tPA, which has a risk of inducing hemorrhage (Hom et al, 2011). Another CT study showed that increased permeability indicated a higher risk for hemorrhagic transformation and suggested that it could be used to select patients for hemicraniectomy ( Figure 2) (Bektas et al, 2010).…”

Section: Neuroimaging Of the Neurovascular Unitmentioning

confidence: 99%

Neurological Diseases in Relation to the Blood–Brain Barrier

Rosenberg

2012

J Cereb Blood Flow Metab

370

270

View full text Add to dashboard Cite

Disruption of the blood-brain barrier (BBB) has an important part in cellular damage in neurological diseases, including acute and chronic cerebral ischemia, brain trauma, multiple sclerosis, brain tumors, and brain infections. The neurovascular unit (NVU) forms the interface between the blood and brain tissues. During an injury, the cascade of molecular events ends in the final common pathway for BBB disruption by free radicals and proteases, which attack membranes and degrade the tight junction proteins in endothelial cells. Free radicals of oxygen and nitrogen and the proteases, matrix metalloproteinases and cyclooxgyenases, are important in the early and delayed BBB disruption as the neuroinflammatory response progresses. Opening of the BBB occurs in neurodegenerative diseases and contributes to the cognitive changes. In addition to the importance of the NVU in acute injury, angiogenesis contributes to the recovery process. The challenges to treatment of the brain diseases involve not only facilitating drug entry into the brain, but also understanding the timing of the molecular cascades to block the early NVU injury without interfering with recovery. This review will describe the molecular and cellular events associated with NVU disruption and potential strategies directed toward restoring its integrity.

show abstract

Section: Neuroimaging Of the Neurovascular Unitmentioning

confidence: 99%

Neurological Diseases in Relation to the Blood–Brain Barrier

Rosenberg

2012

J Cereb Blood Flow Metab

370

270

View full text Add to dashboard Cite

show abstract

“…[7][8][9][10][11] In stroke patients, BBB dysfunction is associated with increased risk of secondary hemorrhage and cerebral edema, further compromising perfusion because of vasospasms or through increased intracranial pressure. 2,7,12,13 However, the spatiotemporal dynamics and mechanisms underlying vascular alterations and the potential link between BBB opening, neurovascular dysfunction and cellular injury after stroke are not fully understood.…”

Section: Introductionmentioning

confidence: 99%

Monitoring Stroke Progression: In Vivo Imaging of Cortical Perfusion, Blood—Brain Barrier Permeability and Cellular Damage in the Rat Photothrombosis Model

Schoknecht

Prager

Vazana

et al. 2014

J Cereb Blood Flow Metab

View full text Add to dashboard Cite

Focal cerebral ischemia is among the main causes of death and disability worldwide. The ischemic core often progresses, invading the peri-ischemic brain; however, assessing the propensity of the peri-ischemic brain to undergo secondary damage, understanding the underlying mechanisms, and adjusting treatment accordingly remain clinically unmet challenges. A significant hallmark of the peri-ischemic brain is dysfunction of the blood-brain barrier (BBB), yet the role of disturbed vascular permeability in stroke progression is unclear. Here we describe a longitudinal in vivo fluorescence imaging approach for the evaluation of cortical perfusion, BBB dysfunction, free radical formation and cellular injury using the photothrombosis vascular occlusion model in male Sprague Dawley rats. Blood-brain barrier dysfunction propagated within the peri-ischemic brain in the first hours after photothrombosis and was associated with free radical formation and cellular injury. Inhibiting free radical signaling significantly reduced progressive cellular damage after photothrombosis, with no significant effect on blood flow and BBB permeability. Our approach allows a dynamic follow-up of cellular events and their response to therapeutics in the acutely injured cerebral cortex.

show abstract

“…12 Ongoing effort to find predictors of HT has yielded various factors, including the etiology of stroke, extent of infarction on initial CT, increasing stroke severity (NIHSS score), increasing age, congestive heart failure, high glucose levels, and blood pressure on presentation. 11,[13][14][15][16][17] Serum markers such as matrix metalloproteinase-9 levels 18 ; imaging modalities such as CT, 19 SPECT, 20 MR imaging, 21 diffusion-and perfusion-weighted MR imaging 22 ; and blood-brain barrier permeability measures on CTP 23 are also under investigation to formulate predictive models for HT.…”

mentioning

confidence: 99%