Lacunar Stroke Is Associated with Diffuse Blood-Brain Barrier Dysfunction
Lacunar Stroke Is Associated with Diffuse Blood-Brain Barrier Dysfunction
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DOI：
10.1002/ana.21549
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发表时间：
2009-02-01
影响因子：
11.2
通讯作者：
Dhillon, Baljean
中科院分区：
文献类型：
--
作者：
Wardlaw, Joanna M.;Doubal, Fergus;Dhillon, Baljean
目的：腔隙性卒中是常见的（占缺血性卒中的25%），主要是由于不明原因的内在脑微血管疾病。虽然主要被认为是缺血性过程，但血管和组织损伤也可以通过功能障碍的内皮或血脑屏障（BBB）泄漏来解释，而不仅仅是缺血。我们在腔隙性脑卒中患者和对照组皮质缺血性脑卒中患者中观察到轻微的全身血脑屏障渗漏。我们评估了131313例脑卒中后至少1个月的灰质、白色物质和脑脊液渗漏，在静脉注射钆之前和之后使用磁共振成像。我们通过两种图像分析方法（感兴趣区域和组织分割）测量静脉注射钆后30分钟的组织增强。我们比较了腔隙性和皮质性患者之间的增强（泄漏），并与关键变量的关联，使用一般线性modeling.Results：我们招募了51腔隙性和46皮质性中风患者。两种分析方法显示，在白色物质（p < 0.001）和脑脊液（p < 0.003）中，腔隙性卒中患者钆后信号增强高于皮质性卒中患者，与其他变量无关。钆后信号增强也与年龄的增加和血管周围空间扩大，但这些并不能解释腔隙性皮质difference.Interpretation：腔隙性卒中患者有微妙的，弥漫性血脑屏障功能障碍的白色的问题。需要进一步的研究来确定BBB功能障碍和/或缺血对腔隙性卒中中微血管和脑异常的相对贡献。
Objective: Lacunar stroke is common (25% of ischemic strokes) and mostly because of an intrinsic cerebral microvascular disease of unknown cause. Although considered primarily to be an ischemic process, the vessel and tissue damage could also be explained by dysfunctional endothelium or blood-brain barrier (BBB) leak, nor just ischemia. We rested for subtle generalized BBB leakiness in patients with lacunar stroke and control patients with cortical ischemic stroke.Methods: We recruited patients with lacunar and mild cortical stroke. We assessed 131313 leak in gray matter, white matter, and cerebrospinal fluid, at least 1 month after stroke, using magnetic resonance imaging before and after intravenous gadolinium. We measured tissue enhancement for 30 minutes after intravenous gadolinium by two image analysis approaches (regions of interest and tissue segmentation). We compared the enhancement (leak) between lacunar and cortical patients, and associations with key variables, using general linear modeling.Results: We recruited 51 lacunar and 46 cortical stroke patients. Signal enhancement after gadolinium was higher in lacunar than cortical stroke patients in white matter (p < 0.001) and cerebrospinal fluid (p < 0.003) by both analysis methods, independent of other variables. Signal enhancement after gadolinium was also associated with increasing age and enlarged perivascular spaces, but these did not explain the lacunar-cortical difference.Interpretation: Patients with lacunar stroke have subtle, diffuse BBB dysfunction in white matter. Further studies are required to determine the relative contributions of BBB dysfunction and/or ischemia to the microvascular and brain abnormalities in lacunar stroke.