Skip to main content

Blood-brain barrier permeability following traumatic brain injury

Introduction

Brain edema and intracranial hypertension is deleterious after traumatic brain injury (TBI), but the underlying pathophysiology is complex and poorly understood. One major subject of controversy is the time course and extent of blood-brain barrier dysfunction following trauma, and previous studies in humans have only provided semi-quantitative data. The objective of the present study was therefore to quantify changes in blood-brain barrier permeability in the early course of TBI.

Methods

Seventeen nonconsecutive brain trauma patients and two controls were included in this prospective observational study. Following i.v. injection of iohexol and CT perfusion scans, patients were scanned eight times from 4 to 25 minutes. The blood-to-brain transfer constant (Ki) for iohexol, reflecting permeability and area available for diffusion, was calculated by Patlak plot analysis of the enhancement curves of intracerebral large venous vessels and pericontusional brain parenchyma.

Results

Fourteen patients were included within 1 day and three were included within 5 days of the injury. In nonischemic tissue surrounding contusions and hematomas, Ki was focally increased in 11 of all included trauma patients and in six of seven patients with raised intracranial pressure. In noninjured areas and in controls, Ki was about 0.06 ml/minute/100 g and increased by 100 to 2,000% in pericontusional tissue. See Figure 1.

Figure 1
figure1

CBF (left) and permeability (right) maps, and contrast-enhanced CT scan (middle).

Conclusion

TBI is associated with early focal increases in blood-brain barrier permeability. The results suggest that in the injured brain, capillary hydrostatic and oncotic pressures are likely to influence edema formation.

References

  1. 1.

    Patlak , et al: Graphical evaluation of blood-to-brain transfer constants from multiple-time uptake data. J Cereb Blood Flow Metab. 1983, 3: 1-3. 10.1038/jcbfm.1983.1.

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Maeda , et al: Ultra-early study of edema formation in cerebral contusion using diffusion MRI and ADC mapping. Acta Neurochir Suppl. 2003, 86: 329-331. 10.1007/978-3-7091-0651-8_70.

    CAS  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to M Jungner.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Jungner, M., Bentzer, P. Blood-brain barrier permeability following traumatic brain injury. Crit Care 16, P312 (2012). https://doi.org/10.1186/cc10919

Download citation

Keywords

  • Traumatic Brain Injury
  • Trauma Patient
  • Brain Edema
  • Intracranial Hypertension
  • Iohexol