Blood-brain barrier integrity in patients with cerebral infarction investigated by computed tomography and serum-CSF-albumin

Abstract

Measurements of CSF-albumin, and S/CSF-albumin in two groups of patients with small and large infarcts failed to show BBB damage to albumin in about one half of the patients. N o significant difference was found between the two groups of patients in regard to the above-mentioned parameters. The localization of the infarcts (close to the CSF or deep in the brain) did not influence the S/CSF-albumin. No correlation was found between the S/CSF-albumin and the time interval between the onset of the stroke and the lumbar puncture within 96 h. Some suggestions are put forward to explain the discrepancies between the CTscan and S/CSF-albumin in the assessment of BBB damage. K e y words: Blood-brain barriercerebral infarctioncerebrospinal fluid -CSF-albumin -CT-scan -S/CSF-albumin.

Biochemical Markers for Blood-Brain Barrier Dysfunction in Acute Ischemic Stroke Correlate with Evolution and Outcome

“…Previous studies have shown that CSF protein, CSF albumin and the AR can serve as an indicator of compromised BBB function in a variety of pathological conditions, among which stroke [25,26,27,28,29]. For this indication, the AR is superior to CSF protein or CSF albumin [25,26,27,28].…”

“…Moreover, BBB abnormality occurred more frequently after thrombolytic therapy and was a predictor of subsequent hemorrhagic transformation and poor outcome [21,22,23,24]. Only 4 studies have evaluated the AR as a parameter for BBB dysfunction in ischemic stroke patients [25,26,27,28,29]. These studies date from the 1980s and 1990s, report on relatively small populations with sampling in the subacute phase of stroke and applied CT-based neuroimaging.…”

“…These studies date from the 1980s and 1990s, report on relatively small populations with sampling in the subacute phase of stroke and applied CT-based neuroimaging. The reported incidence of BBB disruption in the subacute phase was 50–57% and BBB dysfunction was found to correlate with stroke severity and infarct volume in some [26,28], but not in all studies [25,29]. The relatively low incidence of BBB disruption (15%) in our study may probably be the result of sampling in the hyperacute phase of ischemic stroke, in contrast to the other studies evaluating the AR where LP was performed during the second stage of BBB injury [25,26,27,28,29].…”

“…The reported incidence of BBB disruption in the subacute phase was 50–57% and BBB dysfunction was found to correlate with stroke severity and infarct volume in some [26,28], but not in all studies [25,29]. The relatively low incidence of BBB disruption (15%) in our study may probably be the result of sampling in the hyperacute phase of ischemic stroke, in contrast to the other studies evaluating the AR where LP was performed during the second stage of BBB injury [25,26,27,28,29]. Our findings are more in line with the neuroimaging studies on BBB dysfunction in acute stroke, which, however, report with great variability on post-ischemic BBB permeability [21,22,23,24].…”

“…Biochemical parameters for the evaluation of BBB function include analysis of serum constituents in the cerebrospinal fluid (CSF) or analysis of biomarkers in blood. Previous studies have shown that the CSF/serum albumin ratio (AR) is a reliable indicator of compromised BBB function in a variety of pathophysiological conditions, among which is stroke [25,26,27,28,29]. MMP-9 expression in peripheral blood and its temporal profile in the subacute phase appear to reflect ischemic BBB injury and are related to stroke outcome [13].…”