Blood brain barrier integrity in patients with emergent stroke – an MRI study

The use of Cerebrolysin has become a part of routine clinical care for patients with acute ischemic stroke treated with thrombolysis in some countries. Animal data suggest that one of the mechanisms by which Cerebrolysin may exert its benefit is on stabilization of the blood brain barrier (BBB). The BBB controls the movement of molecules and cells from the systemic circulation into the brain.

Acute ischemia can cause disruption of the BBB, and in the setting of severe ischemia the BBB can rupture leading to intracranial hemorrhage. Additionally, in the post-stroke brain, the BBB can become further disrupted due to inflammation. This type of inflammation has been associated with worse functional outcome after stroke. It is hypothesized that post-stroke inflammation may inhibit recovery and could be associated with cognitive decline.

Thus, if Cerebrolysin acts to stabilize the BBB, this may be one mechanism through which it improves recovery after stroke. To test this hypothesis, we will collect MRI scans on patients from two different stroke centers; one that routinely uses Cerebrolysin, and one that does not. BBB disruption will be measured for each population and compared to see if differences in BBB stability post-stroke can be detected.

We hypothesize that BBB disruption will be attenuated in the population treated with Cerebrolysin when compared to the population not treated with Cerebrolysin.