Blood-Brain Barrier Disruption after Cardiac Surgery

Abstract

Background and purpose CNS complications are often seen after heart surgery, and post-surgical disruption of the blood-brain barrier (BBB) may play an etiologic role. The objective of this study was to determine the prevalence of MRI-detected BBB disruption (Hyperintense Acute Reperfusion Marker: HARM) and DWI lesions after cardiac surgery. Materials & methods All patients had an MRI after cardiac surgery. In half the patients (group 1), we administered gadolinium 24 hours after surgery and obtained high-resolution DWI and FLAIR images 24-48 hours later. In the other half (group 2), we administered gadolinium at the time of the post-operative scan (2-4 days after surgery). Two stroke neurologists evaluated the images. Results We studied 19 patients. None of the patients had clinical evidence of a stroke or delirium at the time of the gadolinium administration or the scan, but 9 patients (47%) had HARM (67% in group 1 and 30% in group 2, p=0.18) and 14 patients (74%) had DWI lesions (70% in group 1 and 78% in group 2, p=1.0). Not all patients with DWI lesions had HARM, and not all patients with HARM had DWI lesions (p=0.56). Conclusions Almost half the patients undergoing cardiac surgery have evidence of HARM and three quarters have acute lesions on DWI after surgery. BBB disruption is more prevalent in the first 24 hours after surgery. These findings suggest that MRI can be used as an imaging biomarker to assess therapies that may protect the BBB in patients undergoing heart surgery.

Vessel Wall Enhancement and Blood–Cerebrospinal Fluid Barrier Disruption After Mechanical Thrombectomy in Acute Ischemic Stroke

“…Severe BCSFB disruption defined sulcal gadolinium enhancement or subarachnoid hemorrhage apparent across 10 adjacent slices. 15 A representative case of severe BCSFB disruption is shown in Figure 1B.…”

“…Overall, 60 patients with a median (interquartile range) National Institutes of Health Stroke Scale score 18 (15)(16)(17)(18)(19)(20)(21)(22) at admission were included in the study. A total of 28 patients (47%) received systemic r-tPA before MT.…”

<b>Synapse-specific effects of IL-1β on long-term potentiation in the mouse hip</b><b>pocampus </b>

“…Systemic inflammation due to sepsis and surgery can disrupt the blood-brain barrier (16,24), and elevated levels of pro-inflammatory cytokines in the brain have pathological effects on neural function (15,22). It is well known that pro-inflammatory cytokines modulate synaptic plasticity (15,22) including long-term potentiation (LTP), which is considered the cellular basis of learning and memory (2, 18).…”

Can <b><i>Glycyrrhiza glabra</i></b> L. Reduce Delirium after Coronary Artery Bypass Graft Surgery?

“…Delirium is a major problem after CABG surgery with the approximate reported incidence rate of 20-80% [2]. This complication is associated with increased mortality, longer hospital stay, increased hospital costs, and long-term care [2,3,4]. Regarding the high incidence of delirium in patients undergoing CABG surgery, prophylactic treatment is preferable.…”

“…Regarding the high incidence of delirium in patients undergoing CABG surgery, prophylactic treatment is preferable. Hence, pharmacological neuroprotective strategies have been developed for these patients [3,4]. A meta-analysis indicated that preoperative low-dose and short-term administration of haloperidol or risperidone may modestly reduce delirium occurrence in high-risk patients that need intensive care unit (ICU) [4].…”