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DYNAMIC PATHOPHYSIOLOGY OF CEREBRAL INFARCTION AND REVASCULARIZATION:II. BLOOD-BRAIN BARRIER PERMEABILITY Takeshi Kawase 1 , Masahiro Mizukami 2 , Toshiaki Tazawa 2 , Goro Araki 3 , Ken Nagata 3 1Department of Neurosurgery, School of Medicine, Keio University 2Departnent of Neurosurgery, Institute of Brain and Blood Vessels, Mihara Memorial Hospital 3Departnent of Neurology, Institute of Brain and Blood Vessels, Mihara Memorial Hospital pp.1137-1144
Published Date 1982/12/1
DOI https://doi.org/10.11477/mf.1406205036
  • Abstract
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One hundred patients with occlusive cerebro-vascular diseases were studied to know the sequential change of blood-brain barrier (BBI3) permeability in ischemic stroke. The disruption of BBB was represented as contrast enhancement on computerized tomography (CTCE) and a manifestation of high density focus in the in-farcted zone (hemorrhagic infarction). A total of 446 studies of plain CT and 273 studies of contrastCT were performed. Angiography was followed in all patients and they were allocated to two groups according to the findings on angiograms : 68 patients having any change of occlusive lesion (the group of no-recanalization) and 32 patients showing reopening of occluded vessels (the group of recanalization). Fluorescein cerebral angio-graphy (FCA) and pathological examination were done in 3 patients who underwent surgery due to hemorrhagic infarction occurred in subacute stage of infarction.

In most cases, CTCE became manifest 7 days or more following stroke, and had the peak in-cidence in the third week, and disappeared between one and two month. In the no-recanalized group, CTCE did not occurred during the edema stage (2 to 8 days). Hemorrhagic infarction was rare in no-recanalized group (4%). Whereas in the recanalized group, CTCE appeared even in the acute stage, only when contrast CT was performed immediately after recanalization. CTCE was prominent in all cases during one month of stroke, and hemorrhagic infarction was present in 15 cases (47%). In those cases, high density focus appeared also in the subacute stage (one week to one month) as well as in the acute stage (within one week), and marked CTCE usually preceded the appearance of high density focus. Extravasation of fluorescein dye was shown in those CTCE zone. Pathological specimen demon-strated findings similar to those seen in the resolution stage of infarction. Numerous imma-tured capillaries, without basement membrane, extended from cortex to subcortex, and extra-vasated erythrocytes were found in the perivas-cular spaces.

It is conceivable, therefore, that the reopening of occluded vessels accelerates the permeability of disrupted BBB, which is resulted as marked CTCE and hemorrhagic infarction. Disruption of BBB may be caused not only by ischemic damage of surviving vessels but also by newly formed vessels which are not provided with a BBB in the subacute stage. Low perfusion during ischemia and cerebral edema is considered to supress the BBB permeability.


Copyright © 1982, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

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