The Permissive Nature of Blood Brain Barrier (BBB) Opening in Edema Formation Following Traumatic Brain Injury

Beaumont, Andrew; Marmarou, Anthony; Hayasaki, K.; Barzó, Pál; Fatouros, Panos P.; Corwin, Frank; Marmarou, Christina R.; Dunbar, Jana

doi:10.1007/978-3-7091-6346-7_26

Cited by 72 publications

(72 citation statements)

References 6 publications

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“…Traumatic brain edema has been regarded as a combined event of vasogenic and cellular edemas, although the cellular factor is predominant. 41,45 Thus, our findings may imply a vasogenic factor in the edema formation after TBI.…”

Section: Cerebral Microvascular Responses In Injured Brain Y Lin Et Almentioning

confidence: 63%

“…13,40 There is evidence that the BBB breakdown evaluated by the MRI varies in different experimental TBI models. 13,41 Beaumont et al 41 have reported that in the rat impact acceleration model (IAM) of TBI, the BBB rapidly opens and then fast closes to 36 h after injury, whereas the BBB permeability is increased for 4 h in the CCI TBI model of the rat.…”

Section: Cerebral Microvascular Responses In Injured Brain Y Lin Et Almentioning

confidence: 99%

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Blood–brain barrier permeability is positively correlated with cerebral microvascular perfusion in the early fluid percussion-injured brain of the rat

Lin

Pan

Wang

et al. 2012

Laboratory Investigation

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The blood-brain barrier (BBB) opening following traumatic brain injury (TBI) provides a chance for therapeutic agents to cross the barrier, yet the reduction of the cerebral microvascular perfusion after TBI may limit the intervention. Meanwhile, optimizing the cerebral capillary perfusion by the strategies such as fluid administration may cause brain edema due to the BBB opening post trauma. To guide the TBI therapy, we characterized the relationship between the changes in the cerebral capillary perfusion and BBB permeability after TBI. First, we observed the changes of the cerebral capillary perfusion by the intracardiac perfusion of Evans Blue and the BBB disruption with magnetic resonance imaging (MRI) in the rat subjected to lateral fluid percussion (FP) brain injury. The correlation between two variables was next evaluated with the correlation analysis. Since related to BBB breakdown, matrix metalloproteinase-9 (MMP-9) activity was finally detected by gelatin zymography. We found that the ratios of the perfused microvessel numbers in the lesioned cortices were significantly reduced at 0 and 1 h post trauma compared with that in the normal cortex, which then dramatically recovered at 4 and 24 h after injury, and that the BBB permeability was greatly augmented in the ipsilateral parts at 4, 12, and 24 h, and in the contralateral area at 24 h after injury compared with that in the uninjured brain. The correlation analysis showed that the BBB permeability increase was related to the restoration of the cerebral capillary perfusion over a 24-h period post trauma. Moreover, the gelatin zymography analysis indicated that the MMP-9 activity in the injured brain increased at 4 h and significantly elevated at 12 and 24 h as compared to that at 0 or 1 h after TBI. Our findings demonstrate that the 4 h post trauma is a critical turning point during the development of TBI, and, importantly, the correlation analysis may guide us how to treat TBI.

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Section: Cerebral Microvascular Responses In Injured Brain Y Lin Et Almentioning

confidence: 63%

Section: Cerebral Microvascular Responses In Injured Brain Y Lin Et Almentioning

confidence: 99%

Blood–brain barrier permeability is positively correlated with cerebral microvascular perfusion in the early fluid percussion-injured brain of the rat

Lin

Pan

Wang

et al. 2012

Laboratory Investigation

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“…The absence of vascular changes may also be observed in association with cerebral edema, and it has been shown that the blood-brain barrier opening was clearly not required for edematous formation. 20 Moreover, low vessel density in the deep WM emphasizes the hypothesis that cerebral edema is not induced by the blood-brain barrier opening. 21 It is difficult to evaluate the contribution of the process of TOP in neuropathologic lesions.…”

Section: Discussionmentioning

confidence: 99%

Contribution of Diffusion-Weighted Imaging in the Evaluation of Diffuse White Matter Ischemic Lesions in Fetuses: Correlations with Fetopathologic Findings

Guimiot¹,

Garel²,

Fallet-Bianco³

et al. 2007

AJNR Am J Neuroradiol

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“…Data from experimental studies of brain trauma have shown that edema formation does not correspond with BBB opening and that this is not required for edema formation. 3 In these studies only the permeability of large molecules was investigated, however, and it is reasonable to assume that given various pathological conditions, the BBB may have a significantly reduced reflection coefficient for crystalloids. As in other tissues, transcapillary fluid exchange will then be controlled according to the Starling equilibrium: water exchange across the capillary wall is determined by the differences in hydrostatic and colloid osmotic pressure between the intra-and extracapillary compartments.…”

mentioning

confidence: 99%

Assessment of critical thresholds for cerebral perfusion pressure by performing bedside monitoring of cerebral energy metabolism

Nordström¹

2003

FOC

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An intractable increase in intracranial pressure (ICP) leading to a progressive decrease in cerebral perfusion pressure (CPP) and cerebral blood flow (CBF) is the dominating cause of death in patients with severe brain trauma. Arterial hypotension may further compromise CPP (and CBF) and significantly contributes to death. In addition, the injured brain is sensitive to raised CPP due to an increased permeability of the blood–brain barrier (BBB) to crystalloids and an impaired pressure autoregulation of the CBF. Given these circumstances, an increase in CPP will cause a net transport of water across the BBB and a further elevation in ICP. Accordingly, the assessment of the lower critical threshold for CPP is important for neurological intensive care. This level varies among different patients and different areas of the brain. In fact, the penumbral zones surrounding focal brain lesions appear to be the most sensitive. In the individual patient, preservation of normal cerebral energy metabolism within areas at risk during a decrease in CPP can be guaranteed by performing intracerebral microdialysis and bedside biochemical analyses.

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The Permissive Nature of Blood Brain Barrier (BBB) Opening in Edema Formation Following Traumatic Brain Injury

Cited by 72 publications

References 6 publications

Blood–brain barrier permeability is positively correlated with cerebral microvascular perfusion in the early fluid percussion-injured brain of the rat

Blood–brain barrier permeability is positively correlated with cerebral microvascular perfusion in the early fluid percussion-injured brain of the rat

Contribution of Diffusion-Weighted Imaging in the Evaluation of Diffuse White Matter Ischemic Lesions in Fetuses: Correlations with Fetopathologic Findings

Assessment of critical thresholds for cerebral perfusion pressure by performing bedside monitoring of cerebral energy metabolism

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