Michael Amoo1,2, Jack Henry3, Niall Pender4,5,6, Paul Brennan4,7, Matthew Campbell8, Mohsen Javadpour9,4,6. 1. National Center for Neurosurgery, Beaumont Hospital, Dublin 9, Ireland. michaelamoo@rcsi.ie. 2. Royal College of Surgeons in Ireland, Dublin, Ireland. michaelamoo@rcsi.ie. 3. School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland. 4. Royal College of Surgeons in Ireland, Dublin, Ireland. 5. Department of Clinical Neuropsychology, Beaumont Hospital, Dublin 9, Ireland. 6. Department of Academic Neurology, Trinity College Dublin, Dublin, Ireland. 7. Department of Radiology, Beaumont Hospital, Dublin 9, Ireland. 8. Department of Genetics, Trinity College Dublin, Dublin, Ireland. 9. National Center for Neurosurgery, Beaumont Hospital, Dublin 9, Ireland.
Abstract
BACKGROUND: Aneurysmal subarachnoid haemorrhage is associated with significant morbidity and mortality due to the myriad of complications contributing to early brain injury and delayed cerebral ischaemia. There is increasing interest in the exploration of the association between blood-brain barrier integrity and risks of delayed cerebral ischaemia and poor outcomes. Despite recent advances in cerebral imaging, radiographic imaging of blood-brain barrier disruption, as a biomarker for outcome prediction, has not been adopted in clinical practice. METHODS: We performed a narrative review by searching for articles describing molecular changes or radiological identification of changes in BBB permeability following subarachnoid haemorrhage (SAH) on MEDLINE. Preclinical studies were analysed if reported structural changes and clinical studies were included if they investigated for radiological markers of BBB disruption and its correlation with delayed cerebral ischaemia. RESULTS: There is ample preclinical evidence to suggest that there are structural changes in BBB permeability following SAH. The available clinical literature has demonstrated correlations between permeability imaging and outcomes following aneurysmal subarachnoid haemorrhage (aSAH). CONCLUSION: Radiological biomarkers offer a potential non-invasive prognostication tool and may also allow early identifications of patients who may be at risk of DCI.
BACKGROUND:Aneurysmal subarachnoid haemorrhage is associated with significant morbidity and mortality due to the myriad of complications contributing to early brain injury and delayed cerebral ischaemia. There is increasing interest in the exploration of the association between blood-brain barrier integrity and risks of delayed cerebral ischaemia and poor outcomes. Despite recent advances in cerebral imaging, radiographic imaging of blood-brain barrier disruption, as a biomarker for outcome prediction, has not been adopted in clinical practice. METHODS: We performed a narrative review by searching for articles describing molecular changes or radiological identification of changes in BBB permeability following subarachnoid haemorrhage (SAH) on MEDLINE. Preclinical studies were analysed if reported structural changes and clinical studies were included if they investigated for radiological markers of BBB disruption and its correlation with delayed cerebral ischaemia. RESULTS: There is ample preclinical evidence to suggest that there are structural changes in BBB permeability following SAH. The available clinical literature has demonstrated correlations between permeability imaging and outcomes following aneurysmal subarachnoid haemorrhage (aSAH). CONCLUSION: Radiological biomarkers offer a potential non-invasive prognostication tool and may also allow early identifications of patients who may be at risk of DCI.
Authors: Joshua B Bederson; E Sander Connolly; H Hunt Batjer; Ralph G Dacey; Jacques E Dion; Michael N Diringer; John E Duldner; Robert E Harbaugh; Aman B Patel; Robert H Rosenwasser Journal: Stroke Date: 2009-01-22 Impact factor: 7.914