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Permeability of the Blood-Brain Barrier after Traumatic Brain Injury: Radiological Considerations
Michael Amoo1,2,3, Philip J O'Halloran2,4, Jack Henry5
1National Centre for Neurosurgery, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.
Insights
Traumatic brain injury (TBI) disrupts the blood-brain barrier (BBB), leading to secondary brain injury. This review examines microscopic BBB changes and current imaging methods for evaluating TBI severity and outcomes.
Area of Science:
- Neuroscience
- Pathology
- Radiology
Background:
- Traumatic brain injury (TBI) is a primary cause of death and disability globally, particularly in young individuals.
- Secondary brain injury mechanisms often involve the neurovascular unit (NVU) and blood-brain barrier (BBB) integrity.
- BBB dysfunction after TBI includes loss of tight junction proteins and pericyte alterations.
Purpose of the Study:
- To review microscopic changes within the neurovascular unit following TBI.
- To explore current radiological methods for assessing BBB dysfunction severity and patient outcomes after TBI.
Main Methods:
- Review of existing literature on TBI, NVU, BBB, and radiological imaging.
- Analysis of microscopic alterations at the BBB level post-TBI.
- Evaluation of pre-clinical and clinical radiological adjuncts for BBB assessment.
Main Results:
- TBI causes significant disruption to the BBB, affecting tight junctions, pericytes, and astrocyte end-feet water channels.
- Research is actively seeking reliable biological and radiological biomarkers for BBB dysfunction severity.
- Microscopic changes in the NVU are key to understanding secondary injury progression.
Conclusions:
- Understanding microscopic BBB changes is crucial for TBI management.
- Radiological adjuncts show promise in evaluating BBB integrity and predicting TBI outcomes.
- Further research into biomarkers is essential for optimizing clinical practice and patient outcomes.
Abstract:
Traumatic brain injury (TBI) is a leading cause of death and disability, especially in young persons, and constitutes a major socioeconomic burden worldwide. It is regarded as the leading cause of mortality and morbidity in previously healthy young persons. Most of the mechanisms underpinning the development of secondary brain injury are consequences of disruption of the complex relationship between the cells and proteins constituting the neurovascular unit or a direct result of loss of integrity of the tight junctions (TJ) in the blood-brain barrier (BBB). A number of changes have been described in the BBB after TBI, including loss of TJ proteins, pericyte loss and migration, and altered expressions of water channel proteins at astrocyte end-feet processes. There is a growing research interest in identifying optimal biological and radiological biomarkers of severity of BBB dysfunction and its effects on outcomes after TBI. This review explores the microscopic changes occurring at the neurovascular unit, after TBI, and current radiological adjuncts for its evaluation in pre-clinical and clinical practice.
