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Updated: Feb 13 2020

Blood-Brain Barrier

  • Overview
  • Snapshot
    • A 56-year-old female is brought to the emergency department by her daughter due to new-onset abnormal movements suggestive of a seizure. While the patient is being managed, the physician learns that the patient is being treated for lung cancer. Head CT was obtained after the patient was stabilized.
  • Introduction
    • Structure
      • tight junctions between nonfenestrated capillary endothelial cells
        • also consists of astrocytic foot processes, pericytes, basement membrane
      • irradiation, malignancy, infection can disrupt the blood-brain barrier (BBB)
        • infarction destroys tight junctions → vasogenic edema
          • fluid is extravasated into the interstitial space
    • Function
      • control entry of substances into the brain
        • substances cross via diffusion, ion channels, and selective transport proteins
          • diffusion: nonpolar/lipid-soluble substances readily cross the BBB
            • O2, CO2, heroin, nicotine
          • ion channels: movement of Na+ and K+
          • selective transport proteins: nutrients
            • glucose, amino acids, peptides
            • removes metabolites
      • certain areas of the CNS lack a BBB
        • posterior pituitary (neurohypophysis)
          • allows ADH release from brain into systemic circulation
        • area postrema
          • chemotherapeutic drugs → vomiting
        • organum vasculosum lamina terminalis (OVLT)
          • senses blood osmolality
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