Frequent blood-brain barrier disruption in the human cerebral cortex

Area of Science:

• Neuroscience
• Neurology
• Medical Imaging

Background:

• The blood-brain barrier (BBB) protects the brain but its disruption mechanisms and consequences remain unclear.
• Understanding BBB pathophysiology is crucial for diagnosing and treating neurological disorders.

Purpose of the Study:

• To quantify blood-brain barrier (BBB) disruption using computerized tomography (CT) imaging.
• To investigate the association between BBB disruption and clinical, molecular, and physiological stress markers.

Main Methods:

• Quantification of BBB disruption via CT enhancement levels.
• Measurement of albumin in cerebrospinal fluid (CSF).
• Assessment of blood pressure, body temperature, serum cortisol, and CSF acetylcholinesterase.
• Multielectrode electroencephalography (EEG) to evaluate brain activity.

Main Results:

• BBB disruption observed in 28/43 patients, manifesting as diffuse enhancement and elevated CSF albumin.
• Focal BBB impairment lasting weeks occurred in four patients.
• Significant correlations found between BBB disruption and elevated blood pressure, temperature, cortisol, and stress-related CSF acetylcholinesterase.
• Enhanced slow-wave activity on EEG localized to areas of focal BBB disruption.

Conclusions:

• Minimally invasive quantification of BBB disruption is feasible and correlates with stress indices.
• Persistent BBB disruption is more prevalent in neurological disorders than previously thought.
• BBB disruption may be a significant factor in the pathophysiology of various neurological conditions.