Changes in Background Blood–Brain Barrier Integrity Between Lacunar and Cortical Ischemic Stroke Subtypes

Abstract

Background and Purpose-Lacunar stroke is associated with endothelial dysfunction and histologically with intrinsic cerebral microvascular disease of unknown cause. Endothelial dysfunction could impair blood-brain barrier integrity.We assessed background blood-brain barrier leakage in patients with lacunar ischemic stroke compared with cortical stroke controls. Methods-We recruited patients with lacunar or mild cortical ischemic stroke and assessed generalized cerebral blood-brain barrier leak with MRI and intravenous gadolinium at least 1 month after stroke. We used detailed image processing to compare signal change before and for 30 minutes postcontrast throughout gray matter, white matter, and cerebrospinal fluid with summary analyses and general linear modeling. Results-Among 48 patients (29 lacunar, 19 cortical), postcontrast enhancement was significantly higher in cerebrospinal fluid (Pϭ0.04, Mann-Whitney U), and nonsignificantly higher in white matter, in lacunar than in cortical strokes, with no difference in gray matter. General linear modeling confirmed significantly greater postcontrast enhancement in cerebrospinal fluid in lacunar patients than in cortical controls (tϭ3.37, PϽ0.0008). Conclusion-These preliminary data suggest that the blood-brain barrier may be dysfunctional throughout subcortical white matter (white matter drains via interstitial spaces to cerebrospinal fluid) in patients with lacunar stroke. Further studies are required to confirm these findings and determine whether abnormal blood-brain barrier might predate development of lacunar disease. Blood-brain barrier dysfunction may be an important mechanism for brain damage in cerebral microvascular disease.

Circulating biologic markers of endothelial dysfunction in cerebral small vessel disease: A review

“…44 More recently, contrast-enhanced MRI has been used to study BBB permeability, documenting an increased permeability in the white matter of patients with lacunar stroke compared with patients with cortical stroke. 45 Topakian et al 46 found increased BBB permeability in normal appearing white matter in patients affected by SVD compared with controls, and white-matter lesion severity was an independent predictor of these permeability-related signal changes.…”

Emerging Evidence for Pathogenesis of Sporadic Cerebral Small Vessel Disease

“…The magnetic resonance imaging mean diffusivity discriminates WMH from normal-appearing WM even within the mild range of WMH severity, suggesting that BBB leak is an early predictor of WM damage. 79,80 There are accumulating lines of evidence in support of a pivotal role of the BBB leakage in SVD stroke [81][82][83] and in VCI. 84 Therefore, endothelial damage and subsequent BBB breakdown seem to be pivotal factors contributing to the pathogenesis of SVD.…”

“…Средний коэффициент диффузии при магнитно-резонансной томографии позволяет отли-чить ГБВГМ от нормального БВГМ даже при умерен-ной тяжести ГБВГМ, подтверждая, что повышение проницаемости ГЭБ является ранним предиктором повреждения БВГМ [79,80]. Растет число доказа-тельств в поддержку ключевой роли разрушения ГЭБ при инсульте на фоне БМЦС [81][82][83] и при СКН [84]. Таким образом, повреждение эндотелия и последую-щее разрушение ГЭБ являются основополагающими факторами в патогенезе БМЦС.…”

Increased Cerebral Arterial Pulsatility in Patients With Leukoaraiosis

“…1 However, it is unclear whether leukoaraiosis has a predominantly ischemic etiology due to either chronic ischemia 22,23 or incomplete episodic infarction or whether it represents a primary microangiopathy that directly causes both leukoaraiosis and the associated physiological changes. 5,24 Although both hypotheses could explain the clinical associations, the former hypothesis is supported by studies showing a relationship between the anatomic distribution of leukoaraiosis and lower cerebral blood flow 22 or cerebrovascular reactivity, 25 whereas …”