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This monograph constitutes a comprehensive overview of blood-brain barrier (BBB) permeability changes and related damaging sequelae associated with subarachnoid haemorrhage (SAH). Despite improvements in the surgical and clinical management, patients still experience an unacceptably high morbidity and mortality linked to the presence of subarachnoid blood. In this monograph, the authors have reviewed the historical basis of this problem, the anatomical substrates of the BBB, the occurrence and adverse consequences of barrier disruption following SAH, the related sequelae of oedema formation, ICP alteration and vasospasm discussed from both the basic science and clinical perspective, with the consideration of multiple clinical and laboratory investigative tools, including all aspects of modern imaging. The text is supplemented by presenting key research publications in the field, focusing on the damaging consequences of subarachnoid blood, while attempting to explain the hierarchy o f events in those progressive changes associated with BBB perturbation, including vasospasm, ischaemia and elevated intracranial pressure.
List of contents
The Concept of the BBB: A Historical Perspective.- Anatomy of the BBB.- Pathophysiology of BBB.- Brain Oedema.- Breakdown of the BBB.- BBB Dysfunction after SAH.- Clinical Monitoring.- Neuroradiological Findings of BBB Dysfunction after SAH.- Computerised Tomography and Magnetic Resonance SPECT and PET.- Experimental Data.- Literature Review of BBB Dysfunction after Experimental SAH.- Qualitative Assessments of BBB Dysfunction after SAH.- Quantitative Assessments of BBB Dysfunction.- Time Course of BBB Dysfunction after SAH.- Additional Pathophysiological Changes after SAH.- Strategies for Pharmacological Intervention.- Hydroxyl Radical Scavenger AVS.- Glutamate Antagonist Felbamate.- Calpain Inhibitor II.- Challenges and Future Direction.- Advances in Cerebrovascular Pathophysiology.- Gene Therapy.- References.
