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Article CommentaryBrain
Open Access

Blood-Brain Barrier Disruption after Cardiac Surgery

J.G. Merino, L.L. Latour, A. Tso, K.Y. Lee, D.W. Kang, L.A. Davis, R.M. Lazar, K.A. Horvath, P.J. Corso and S. Warach
American Journal of Neuroradiology March 2013, 34 (3) 518-523; DOI: https://doi.org/10.3174/ajnr.A3251
J.G. Merino
aFrom the section on Stroke Diagnostics and Therapeutics (J.G.M., L.L.L., L.A.D., S.W.), National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
bJohns Hopkins Community Physicians (J.G.M., K.A.H.), Bethesda, Maryland
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L.L. Latour
aFrom the section on Stroke Diagnostics and Therapeutics (J.G.M., L.L.L., L.A.D., S.W.), National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
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A. Tso
cDepartment of Neurology (A.T.), University of California San Francisco, San Francisco, California
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K.Y. Lee
dDepartment of Neurology (K.Y.L.), Yonsei University College of Medicine, Seoul, Republic of Korea
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D.W. Kang
eAsan Medical Center (D.W.K.), Seoul, Republic of Korea
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L.A. Davis
aFrom the section on Stroke Diagnostics and Therapeutics (J.G.M., L.L.L., L.A.D., S.W.), National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
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R.M. Lazar
fDepartment of Neurology (R.M.L.), Columbia University College of Physicians and Surgeons, New York, New York
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K.A. Horvath
bJohns Hopkins Community Physicians (J.G.M., K.A.H.), Bethesda, Maryland
gCardiothoracic Surgery Research (K.A.H.), National Heart Lung and Blood Institute, Bethesda, Maryland
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P.J. Corso
hDepartment of Cardiac Surgery (P.J.C.), Washington Hospital Center, Washington, DC.
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S. Warach
aFrom the section on Stroke Diagnostics and Therapeutics (J.G.M., L.L.L., L.A.D., S.W.), National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
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    Fig. 1.

    Classification of HARM by location and severity. Definitions used for HARM classification.

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    Fig. 2.

    A 74-year-old man who underwent off-pump CABG. A, Baseline FLAIR obtained before surgery. B, Postgadolinium scan. Gadolinium was administered 20 hours after surgery, and 3T MR imaging was performed 20 hours later. Postgadolinium FLAIR shows enhancement throughout the subarachnoid space (severe sulcal and background HARM). The CSF in the ventricles appears gray (mild/moderate ventricular HARM). Gadolinium enhancement is also seen in the eye. C, DWI obtained after surgery. Patient had 4 DWI lesions.

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    Fig. 3.

    An 86-year-old man who underwent CABG. A, Baseline FLAIR performed before surgery. B, Postgadolinium FLAIR. Gadolinium was administered 23 hours after surgery, and the 1.5T MR imaging was obtained 27 hours later. Postgadolinium FLAIR shows bright enhancement in the right frontal and left parietal subarachnoid space (arrows, severe sulcal HARM). C, Postoperative DWI. The patient had 6 DWI lesions.

Tables

  • Figures
  • Association of HARM and DWI lesions

    HARMTotal
    YesNo
    DWI Lesion7714 (74%)
    No DWI Lesion235
    Total9 (47%)1019
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American Journal of Neuroradiology: 34 (3)
American Journal of Neuroradiology
Vol. 34, Issue 3
1 Mar 2013
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Blood-Brain Barrier Disruption after Cardiac Surgery
J.G. Merino, L.L. Latour, A. Tso, K.Y. Lee, D.W. Kang, L.A. Davis, R.M. Lazar, K.A. Horvath, P.J. Corso, S. Warach
American Journal of Neuroradiology Mar 2013, 34 (3) 518-523; DOI: 10.3174/ajnr.A3251

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Blood-Brain Barrier Disruption after Cardiac Surgery
J.G. Merino, L.L. Latour, A. Tso, K.Y. Lee, D.W. Kang, L.A. Davis, R.M. Lazar, K.A. Horvath, P.J. Corso, S. Warach
American Journal of Neuroradiology Mar 2013, 34 (3) 518-523; DOI: 10.3174/ajnr.A3251
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  • Pericortical Enhancement on Delayed Postgadolinium Fluid-Attenuated Inversion Recovery Images in Normal Aging, Mild Cognitive Impairment, and Alzheimer Disease
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  • Vessel Wall Enhancement and Blood-Cerebrospinal Fluid Barrier Disruption After Mechanical Thrombectomy in Acute Ischemic Stroke
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