Editors' Note: Blood-Brain Barrier Permeability in Patients With Reversible Cerebral Vasoconstriction Syndrome Assessed With Dynamic Contrast-Enhanced MRI

Abstract

Using dynamic contrast-enhanced MRI, Dr. Wu and colleagues evaluated the blood-brain barrier function in a prospective cohort of patients with reversible cerebral vasoconstriction syndrome (RCVS). The investigators found marked elevations in Ktrans—a validated index of microscopic blood-brain barrier disruption—in the acute phase of RCVS, which declined with time. These findings paralleled the course of vasoconstriction and development of white matter hyperintensities. Dr. Gupta comments on one important limitation of these findings in that they do not explain the relationship between the predisposing risk factors and clinical manifestations with the pathogenesis of RCVS. For instance, there is a time gap between the thunderclap headache of RCVS and the subsequent MRI findings. The investigators agree that the relationships observed between blood-brain barrier dysfunction and clinical disease are more likely to be those of association, although causation cannot be wholly excluded. Using dynamic contrast-enhanced MRI, Dr. Wu and colleagues evaluated the blood-brain barrier function in a prospective cohort of patients with reversible cerebral vasoconstriction syndrome (RCVS). The investigators found marked elevations in Ktrans—a validated index of microscopic blood-brain barrier disruption—in the acute phase of RCVS, which declined with time. These findings paralleled the course of vasoconstriction and development of white matter hyperintensities. Dr. Gupta comments on one important limitation of these findings in that they do not explain the relationship between the predisposing risk factors and clinical manifestations with the pathogenesis of RCVS. For instance, there is a time gap between the thunderclap headache of RCVS and the subsequent MRI findings. The investigators agree that the relationships observed between blood-brain barrier dysfunction and clinical disease are more likely to be those of association, although causation cannot be wholly excluded.