This Article Full Text Full Text (PDF) All Versions of this Article: 39/4/1327    most recent STROKEAHA.107.500124v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Wardlaw, J. M. Articles by Dennis, M. S. PubMed PubMed Citation Articles by Wardlaw, J. M. Articles by Dennis, M. S. Related Collections Other Vascular biology CT and MRI Cerebral Lacunes

(Stroke. 2008;39:1327.)
© 2008 American Heart Association, Inc.

Research Letters

Changes in Background Blood–Brain Barrier Integrity Between Lacunar and Cortical Ischemic Stroke Subtypes

Joanna M. Wardlaw, FRCR, FRCP(E), FMedSci; Andrew Farrall, FRCR(Can); Paul A. Armitage, PhD; Trevor Carpenter, BSc, PhD; Francesca Chappell, BSc, MA, MSc; Fergus Doubal, MRCP; Debashish Chowdhury, MD, DM; Vera Cvoro, MRCP Martin S. Dennis, FRCP(E)

From Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh, UK.

Correspondence to J. Wardlaw, Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Crewe Rd, Edinburgh, EH4 2XU, UK. E-mail joanna.wardlaw{at}ed.ac.uk

Abstract

Background and Purpose— Lacunar stroke is associated with endothelial dysfunction and histologically with intrinsic cerebral microvascular disease of unknown cause. Endothelial dysfunction could impair blood–brain barrier integrity. We assessed background blood–brain barrier leakage in patients with lacunar ischemic stroke compared with cortical stroke controls.

Methods— We recruited patients with lacunar or mild cortical ischemic stroke and assessed generalized cerebral blood–brain barrier leak with MRI and intravenous gadolinium at least 1 month after stroke. We used detailed image processing to compare signal change before and for 30 minutes postcontrast throughout gray matter, white matter, and cerebrospinal fluid with summary analyses and general linear modeling.

Results— Among 48 patients (29 lacunar, 19 cortical), postcontrast enhancement was significantly higher in cerebrospinal fluid (P=0.04, Mann-Whitney U), and nonsignificantly higher in white matter, in lacunar than in cortical strokes, with no difference in gray matter. General linear modeling confirmed significantly greater postcontrast enhancement in cerebrospinal fluid in lacunar patients than in cortical controls (t=3.37, P<0.0008).

Conclusion— These preliminary data suggest that the blood–brain barrier may be dysfunctional throughout subcortical white matter (white matter drains via interstitial spaces to cerebrospinal fluid) in patients with lacunar stroke. Further studies are required to confirm these findings and determine whether abnormal blood–brain barrier might predate development of lacunar disease. Blood–brain barrier dysfunction may be an important mechanism for brain damage in cerebral microvascular disease.

Key Words: blood-brain barrier • cerebral infarction • cerebral small vessel disease • endothelium • lacunar stroke • magnetic resonance imaging