Blood-Brain Barrier Permeability Changes after Subarachnoid Haemorrhage: An Update : Clinical Implications

This monograph by Antonino Germano and Francesco Tomasello with contributions of Giuseppe Anastasi, Placido Bramanti, and Domenico dAvella, constitutes a comprehensive, yet focused overview of those blood brain barrier permeability changes and related damaging sequelae associated with the presence of subarachnoid blood commonly linked to aneurysmal bleeding. As noted by the authors, despite improvements in the surgical and clinical management of aneurysms and their associated bleeding, these patients still experience an unacceptably high morbidity and mortality linked to the presence of subarachnoid blood. In this monograph, Dr. Germano and colleagues review the historical basis of this problem, providing detailed descriptions of the anatomical substrates of the blood-brain barrier, while discussing the occurrence and adverse consequences of barrier disruption following subarachnoid haemorrhage. The related sequelae of oedema formation, intracranial pressure alteration and vasospasm are 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 tabular data presenting key research publications in the field, focusing on the damaging consequences of subarachnoid blood, while attempting to explain the hierarchy of events in those progressive changes associated with blood-brain barrier perturbation, including vasospasm, ischaemia and elevated intracranial pressure. The monograph also includes detailed consideration of Dr. Germanos research efforts in animals model using autologous arterial blood injected into the cisterna magna."