Saturday, 8 June 2013

Do the Brain Benefits of Exercise Last?

 

It is well established that exercise bolsters the structure and function of the brain. Multiple animal and human studies have shown that a few months of moderate exercise can create new neurons, lift mood and hone memory and thinking.
But few studies have gone on to examine what happens next. Are these desirable brain changes permanent? Or, if someone begins exercising but then stops, does the brain revert to its former state, much like unused muscles slacken?
The question may be particularly relevant at this time of year, when so many people start new exercise programs. Helpfully, two recent animal studies that were presented at the 2012 annual meeting of the Society for Neuroscience in New Orleans have taken on the issue and may have relevance for people, though the results are disquieting.
Of the two experiments, the more dramatic looked at what happens to the brain’s memory center when exercise is stopped.
Researchers from the University of Sao Paulo in Brazil began by allowing half of a group of healthy, adult rats to run at will on running wheels. Rats enjoy that activity and, for a week, they enthusiastically skittered on their wheels. The animals were also injected with a substance that marks newborn neurons in the hippocampus, or memory center of the brain, so that the scientists would be able to track how many cells had been created. Inactive animals, including people, create new brain cells, but exercise is known to spark the creation of two or three times as many new hippocampal neurons.
A separate control group was housed in cages with locked wheels, so that they remained sedentary. They were also monitored for new brain cell growth.
After a week, the runners’ wheels were locked and they, too, became inactive.
A week later, some of the exercised and control rats completed memory testing that required them to find, then remember, the location of a platform placed along the wall of a small swimming pool. (Rats aren’t fond of being in the water, and the platform allowed them to clamber out.) Those with better memories remembered and paddled to the platform more quickly.
The remaining animals completed the same memory test after either three weeks or six weeks of inactivity.
Afterward, the researchers compared the animals’ performance on the memory test, as well as the number of new brain cells in the hippocampus of each group of rats.
They found that, after only a week of inactivity, the rats that had run were much faster on the water maze test than the control animals. They also had at least twice as many newborn neurons in the hippocampus.
But those advantages faded after several more weeks of not running. The brains of the animals that had been inactive for three weeks contained far fewer newborn neurons than the brains of the animals that had rested for only one week. The brains of the animals that had been inactive for six weeks had fewer still.
The animals inactive for three or six weeks also performed far worse on the water maze test than the animals that had been inactive for only a single week. In fact, their memories were about as porous of those of the control animals, “indicating,” the authors write, “that the exercise-induced benefits may be transient.”
The other new study of exercise-induced brain changes found that they were similarly fragile, although this study explored the impacts of exercise on mood.
In earlier experiments by the same group of scientists, from McMaster University in Hamilton, Ontario, rats given access to a running wheel, toys and other types of environmental enrichment were able to use serotonin, a neurotransmitter involved in anxiety and other moods, more efficiently. After several months of exercise, the exercised animals became noticeably less anxious and more resilient to stress during behavioral testing. But that savoir-faire dissipated rapidly if they were removed from the cages with running wheels and toys.
In their latest experiment, also presented at the Society for Neuroscience meeting, the researchers reported that after 10 weeks of running, followed by three weeks of inactivity, the running rats’ brains were almost indistinguishable from those of animals that had never exercised. They had almost comparable levels of an enzyme in the brain that affects the synthesis and uptake of serotonin. It was as if they had never run.
In other words, the brain benefits “wear off quickly,” said Dr. Michael Mazurek, a professor of neurology at McMaster, who oversaw the study. “This is analogous to what happens to muscle bulk or heart rate following exercise withdrawal.”
Gilberto Xavier, a professor of psychology at the University of Sao Paulo and senior author of the study of hippocampal neurons, agrees. “Brain changes are not maintained when regular physical exercise is interrupted,” he said, adding that, “though our observations are restricted to rats, indirect evidence suggests that the same phenomenon occurs in human beings.”
Meaning that the lessons of both studies point in the same direction. For the ongoing health of our minds, as well as for the plentiful other health benefits of exercise, it might be wise to stick to those New Year’s exercise resolutions.

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Train Your Brain With Exercise

 
By
WebMD Feature
 
Not only is exercise smart for your heart and weight, but it can make you smarter and better at what you do.

Anyone with a brain exercises these days, but did you know exercise can return the favor and train your brain? Not only is exercise smart for your heart and weight, but it can make you smarter and better at what you do.
"I like to say that exercise is like taking a little Prozac or a little Ritalin at just the right moment," says John J. Ratey, MD, an associate professor of psychiatry at Harvard Medical School and author of A User's Guide to the Brain. "Exercise is really for the brain, not the body. It affects mood, vitality, alertness, and feelings of well-being."
Stephen C. Putnam, MEd, took up canoeing in a serious way to combat the symptoms of adult ADHD (attention deficit hyperactivity disorder). Then he wrote a book, titled Nature's Ritalin for the Marathon Mind, about the benefits of exercise on troublesome brain disorders such as ADHD, a neurological/behavioral condition resulting in hyperactivity and the inability to focus on tasks.
Putnam cites studies of children who ran around for 15 to 45 minutes before class and cut their ants-in-the-pants behavior by half when they got to class. As with most exercise, the effects were relatively lasting -- smoothing out behavior two to four hours after the exercise.
Putnam also points to some preliminary animal research that suggests that exercise can cause new stem cells to grow, refreshing the brain and other body parts. According to Ratey, exercise also stimulates nerve growth factors. "I call it Miracle-Gro for the brain," he says.

How Exercise Trains the Brain

Christin Anderson, MS, wellness and fitness coordinator of the University of San Francisco, explains that exercise affects many sites within the nervous system and sets off pleasure chemicals such as serotonin and dopamine that make us feel calm, happy, and euphoric.
In other words, if you don't want to wait for those good feelings to come by accident (if they do), you can bring them on by exercising.
"When one exercises," Anderson says, "you can think more clearly, perform better, and your morale is better. This is pure science -- stimulate your nervous system and function at a higher level."

Effects of Exercise on Depression

Almost everyone has heard of the "fog of war," but the "fog of living" is depression. "Depression affects memory and effectiveness (not to mention the ability to get up, get dressed, and function)," Anderson says. "If you can control your physiology, you can relax, focus, and remember."
In a study reported in the Journal of Sports Medicine and Physical Fitness in 2001, 80 young male and female volunteers were tested for mood and then did aerobics for an hour. Of the 80, 52 were depressed before the exercise. That group was the most likely to benefit, reporting a reduction in anger, fatigue, and tension. They also felt more vigorous after the workout.

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Brain abscess

A brain abscess is a collection of pus, immune cells, and other material in the brain, usually from a bacterial or fungal infection.

Causes

Brain abscesses commonly occur when bacteria or fungi infect part of the brain. Swelling and irritation (inflammation) develop in response to this infection. Infected brain cells, white blood cells, live and dead bacteria, and fungi collect in an area of the brain. Tissue forms around this area and creates a mass.
While this immune response can protect the brain by isolating the infection, it can also do more harm than good. The brain swells. Because the skull cannot expand, the mass may put pressure on delicate brain tissue. Infected material can block the blood vessels of the brain.
The germs that cause a brain abscess can reach the brain through the blood. The source of the infection is often not found. However, the most common source is a lung infection. Less often, a heart infection is the cause. Germs may also travel from a nearby infected area (for example, an ear infection or a tooth abscess) or enter the body during an injury (such as a gun or knife wound) or neurosurgery.
In children with congenital heart disease or a blood vessel birth defect, such as those with Tetralogy of Fallot, infections are more able to reach the brain from the intestines, teeth, or other body areas.
The following raise your risk of a brain abscess:
  • A weakened immune system (such as in AIDS patients)
  • Chronic disease, such as cancer 
  • Drugs that suppress the immune system (corticosteroids or chemotherapy)
  • Right-to-left heart shunts, usually the result of congenital heart disease

Symptoms

Symptoms may develop slowly, over a period of 2 weeks, or they may develop suddenly. They may include:

Exams and Tests

A brain and nervous system (neurological) exam will usually show signs of increased intracranial pressure and problems with brain function.
Tests to diagnose a brain abscess may include:
A needle biopsy is usually performed to identify the cause of the infection.

Treatment

A brain abscess is a medical emergency. Pressure inside the skull may become high enough to be life threatening. You will need to stay in the hospital until the condition is stable. Some people may need life support.
Medication, not surgery, is recommended if you have:
  • Several abscesses (rare)
  • A small abscess (less than 2 cm)
  • An abscess deep in the brain
  • An abscess and meningitis
  • Shunts in the brain for hydrocephalus (in some cases the shunt may need to be removed temporarily or replaced)
  • Toxoplasma gondii infection in a person with HIV
Antibiotics will be prescribed. Antibiotics that work against a number of different bacteria (broad spectrum antibiotics) are most commonly used. You may be prescribed several different types of antibiotics to make sure treatment works.
Antifungal medications may also be prescribed if the infection is likely caused by a fungus.
Immediate treatment may be needed if an abscess is injuring brain tissue by pressing on it, or there is a large abscess with a large amount of swelling around that it is raising pressure in the brain.
Surgery is needed if :
  • Increased pressure in the brain continues or gets worse
  • The brain abscess does not get smaller after medication
  • The brain abscess contains gas (produced by some types of bacteria)
  • The brain abscess might break open (rupture)
Surgery consists of opening the skull, exposing the brain, and draining the abscess. Laboratory tests are often done to examine the fluid. This can help identify what is causing the infection, so that more appropriate antibiotics or antifungal drugs can be prescribed.
The surgical procedure used depends on the size and depth of the abscess. The entire abscess may be removed (excised) if it is near the surface and enclosed in a sac.
Needle aspiration guided by CT or MRI scan may be needed for a deep abscess. During this procedure, medications may be injected directly into the mass.
Certain diuretics and steroids may also be used to reduce swelling of the brain.

Outlook (Prognosis)

If untreated, a brain abscess is almost always deadly. With treatment, the death rate is about 10 - 30%. The earlier treatment is received, the better.
Some patients may have long-term neurological problems after surgery.

Possible Complications

  • Brain damage
  • Meningitis that is severe and life threatening
  • Return (recurrence) of infection
  • Seizures

When to Contact a Medical Professional

Go to a hospital emergency room or call the local emergency number (such as 911) if you have symptoms of a brain abscess.

Prevention

You can reduce the risk of developing a brain abscess by treating any disorders that can cause them. Have a follow-up examination after infections are treated.
Some people, including those with certain heart disorders, may receive antibiotics before dental or urological procedures to help reduce the risk of infection.

Alternative Names

Abscess - brain; Cerebral abscess; CNS abscess

References

Nath A, Berger J. Brain abscess and parameningeal infections. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 421.
Tunkel AR. Brain abscess. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 88.

Update Date: 10/6/2012

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc. 

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How to Decrease Your Brain Age

 Edited by TheGreatDeciever, Jaysmomma, Krystle, Tipsy and 16 others

Steps


Part One: Testing Your Current Brain Age


  1. Check your reaction time. Ask another person to hold a 12" (30 cm) ruler in front of you.
    • Place your open hand under the ruler and have your tester drop the ruler without letting you know. Catch it when you can.
    • See where you rate (distance passed when caught):
      • Less than 4" (10 cm) = age 20
      • 6" (15 cm) = age 25
      • 8" (20 cm) = age 30
      • 10" (25 cm) = age 35
      • 12" (30 cm) or a complete miss = age 40+
  2. Test your balance. Stand up. Raise one leg to the front with your knee bent at a right angle and hold your arms out to the sides.
    • Close your eyes and see how long you can hold this position. Just make sure, especially if you're older, that you have someone there to catch you if you fall or that you have a soft place to land.
    • Check your results (time passed before having to return leg to floor):
      • Over 30 seconds = age 20
      • 20 to 30 seconds = age 30
      • 15 to 20 seconds = age 40
      • 10 to 15 seconds = age 50
      • Less than 10 seconds = age 60.
  3. Evaluate your memory. You'll need a partner for this test.
    • Write out a list of 6 different sentences. Have someone else place 2 mixed up letters (and/or symbols) on Line 1, 4 on Line 2, 6 on Line 3, 8 on Line 4, 10 on Line 5, and 12 on Line 6.
    • Read a line and then cover that line up. Write down what you have remember next to the covered up line. Repeat this step until you've gone through each line.
    • Calculate how much of each sentence you remembered correctly and write it down as a percentage. Add all 6 percentages and then divide that number by a total of 6 to get an average.
    • Rate yourself (by percentage correct):
      • 100% = age 20
      • 90% = age 30
      • 80% = age 40
      • 70% = age 50
      • 60% = age 60
      • 50% = age 70
      • 40% = age 80
      • 30% or below = age 90[2]

Part Two: Sharpening Your Brain With Healthy Habits

  1. Pick out foods that feed your brain. Find a balance between food types, keeping processed foods to a minimum and choosing healthy fats, proteins and carbohydrates to fuel your brain.
  2. Choose healthy fats. Here are some things that you can do to increase your intake of good fats:
    • Cook with healthy oils like olive oil and canola oil
    • Add more omega 3 fats by eating foods such as salmon, walnuts and flax seeds.
    • Take a PS supplement. Phosphatidylserine (PS) is a phospholipid found in abundance in your brain cells. Taking supplements of PS and other phospholipids may boost your mood, memory and concentration.[3][4]
  3. Try other supplements. Lecithin granules, ginkgo biloba, niacin, B12, the amino acid pyroglutamate and B5 are also helpful brain boosters.[5]
  4. Eat foods containing B vitamins and Vitamin E. Leafy greens and lean meats are good choices.[6]

  5. Eat more plant foods. When you eat a meal, half of your plate should contain either fruits or vegetables.
    • Choose a variety of colorful fruits. For example, combine strawberries, plums, bananas and kiwi. You can also make a fruit salad to serve with a meal or as a meal in itself.[7]
    • Vary your colors when you eat vegetables. Mix it up by eating sweet potatoes, spinach, black beans and green peas.
    • Fruits and vegetables are good sources of antioxidants. Foods that contain a lot of antioxidants and phenols help to both prevent cell damage and break down special fats that are important to your brain.[8]
  6. Drink more water Your brain consists of 85 percent water. Therefore, for the health of your brain as well as the rest of your body, drink 8 8-ounce (240 ml) of water every day.
  7. Avoid foods that age your brain. These include:
    • Baked goods containing white flour and processed sugar including doughnuts, cakes, cookies, pies and pastries
    • Alcohol[9]
    • Hard cheeses and processed dairy products
    • Sugary foods like soft drinks, fruit drinks and sugary breakfast cereals
    • Creamy sauces
    • Hydrogenated oils and trans fats
    • Mayonnaise
    • Packaged convenience foods and fast food[10]
  8. Exercise your body. After age 25, our taken-for-granted physical health begins to decline, helped along by inactive lifestyles. Physical exercise is important for your brain because it provides much needed oxygen; improved blood flow to the brain helps the growth of new brain cell "branches" (dendrites).[11]
    • People who exercise have been shown to have denser brains than those who do not. Loss of brain density and volume becomes more prevalent as we age and is a major factor in mental decline.[12]
    • Weight bearing exercise has been shown to improve levels of serotonin and dopamine in adults, which are two brain chemicals related directly to brain aging.[13]
  9. Practice good sleeping habits. Sleep is a powerful way to combat aging.
    • Research has shown that a regular 8-hour sleep pattern slows age decline and protects people against chronic age-related memory loss.[14]
    • Go to bed at the same time every night and rise at the same time every morning. Make sure to get 7 to 8 hours of sleep. Your brain will be grateful — and younger — for the much needed consistent and regular recharging.

Part Three: Sharpen Your Brain With Mental Exercises

  1. Solve puzzles. Puzzles such as crosswords, Sudoku, trivia games, brainteasers, mazes and word puzzles[15] are all superb mental workouts.
  2. Memorize sequences of numbers, letters, words or symbols. Do this with a friend so that you can both improve your memory.
  3. Play memory games. For example, place different objects on a tray, try to memorize them and then cover them up and repeat what they are. Continuously increase the number of objects you're trying to remember.
  4. Play games on your computer. The best games require you to solve mathematical problems quickly. Puzzles that require you to race against the clock are also helpful.[16]
  5. Take advantage of down time. Try to remember chunks of text, phone numbers, lines of printed letters or anything else that you can spot around you.
    • Try to remember things about people sitting near you. Close your eyes and try to remember things about them and check if you got it right (take care not to stare).
    • You can also do this with pictures in a magazine that are filled with action or elements. Stare at a picture for 10 seconds. Then, write down as many things as possible that you can remember about it and compare your recall after.[17]
    • Become a good storyteller. This is a great way to keep your memories alive and helps you to perceive past events in a positive light, by using the storyteller's technique of finding a moral, a lesson, or a confirmation within the past experience.
  6. Read lots of good books. Reading has long been a guaranteed way to keep your brain alert and attuned to new ideas and perspectives.
  7. Try something new. "Neuroplasticity" is the term used to explain the brain's ability to reorganize its neural pathways based on a new experiences.[18]
    • Try a new way of doing something that you've always done. This is a really good way to create new patterns in your brain.
    • Learn a new skill. Learning new skills will continuously push your brain and will give you opportunities to meet new people, sample new experiences and introduce variety into your life. Trying something new can actually help you to "declutter" your brain and remove irrelevant information and replace it with useful information. [19]

  8. Learn a new language. Teaching yourself a new language is one of the most rewarding mental workouts. When you're proficient, you can plan a trip to a country that speaks that language to give yourself a rewarding new experience.

  9. Try tutoring. When you teach others, you draw on past experiences and apply them in a different way. You will also draw on many problem-solving skills when teaching or tutoring.

Part Four: Decrease Your Brain's Age With Good Mental Health Practices


  1. Cope with stress. Stress is good for you in small doses because it keeps you on your toes and it helps to remind you that you're alive and need to be careful in certain situations. Excess, pronounced, and never-ending stress typical of our modern way of living, however, kills brains cells and ages your brain faster. To decrease your brain age, reduce your exposure to and intolerance of stress by finding ways that minimize it, ways that work for you. Some ideas include:
    • Meditating. Meditation is one of the more effective methods for reducing stress in your life and it can be done at home, at work and even while traveling.
    • Taking up a physical activity that releases stress, such as yoga, martial arts, kickboxing or tennis.
    • Learning to be more assertive and to express yourself. Assertive people are better able to state their needs and wants politely but firmly. Expressing yourself clearly and refusing to allow yourself to be used or swayed by others is a good way of keeping stress at bay.
    • Exercising more. Exercise wards off the effects of stress by burning off the stress hormones and chasing away the cortisol that destroys brain cells. Mood improves with exercise too, as noradrenaline is secreted and endorphins enter the bloodstream. These substances give you a lift and help to ward off depression.[20][21]

  2. Improve your attitude. Your attitude affects brain activity and influences your mood and emotional state. A positive outlook that allows you to maintain a belief in your value and self-worth will allow you to live a fulfilled life in which your brain remains open to new possibilities. On the other hand, constant negative thinking can easily shut you off from continued learning and growth, which will cause your brain to age faster.
    • Learn to control negative thinking. The first step is to recognize negative thoughts. The second step is to change the thoughts to something more realistic and positive. Changing negative thinking is the same as changing any other bad habit. The more you practice positive thinking, the more your brain will respond.
    • Work on your emotional intelligence. When you have emotional intelligence, you can recognize your emotions, reason with them and use them to enhance thought.[22] You will be more creative, make better decisions and implement positive solutions to problems. The better you get at mastering your own emotions, the better you'll become at enabling constructive emotions in others as well, which will create more fruitful connections in your life.[23]
    • Reframe the Past in your mind. While you cannot change the past, you can change your attitude toward it and avoid slipping into a victim mentality. Re-examine events that brought you shame, guilt, humiliation, sadness and fear so that you can let them go and move forward.[24] You'll decrease your brain age with a better attitude because you'll remove useless, energy-sapping thoughts and replace them with healthier, forward-looking and self-forgiving thoughts that will energize you.

  3. Do What You Love. People who love what they're doing in life tend to experience a greater sense of purpose and happiness. You may not be in your dream job, activity or relationship, but you can find things to be grateful for in the life you're leading. Mix up work tasks every day and pursue plenty of other activities to add playfulness, interest and fun into your life.

  4. Give mental exercises 100 percent of your effort. When undertaking mental workouts, be sure to focus and concentrate properly. You won't get benefits from simply going through the motions – you must really throw yourself into doing the mental workout activities with full attention.[25]

Part Five: Other Tips for Decreasing Your Brain's Age


  1. Nurture your spiritual self. Whatever your beliefs or lack of them, nurturing your spiritual self or connecting to the awe and wonder of life is an important aspect of keeping your brain young.[26]
    • Our brains are wired for spiritual experiences, such as times that we take a holistic approach to our place in the world and seek complete well-being and a sense of purpose.[27]
    • Practice prayer, meditation, reflection, taking time out or whatever allows you to focus on your spiritual self. This will give your brain the space to make connections and to seek "the flow" of life in which heart, mind, and body all work as one.
    • Nurturing your spiritual self increases your compassion for both yourself and for others, allowing you to connect better with others and thereby enhance your brain functioning.[28]

  2. Choose purple to boost your brain. Purple, including shades of violet and lavender, may improve your ability to think and achieve.[29] Purple is associated with memory, imagination, creativity, wisdom, and strategic problem-solving, so adding more of this color into your life can help focus your brain.[30]
    • Buy some purple supplies. Buy purple picture frames, office supplies or even a purple cell phone.
    • Surround yourself with purple. Paint your walls purple. Wear purple clothes or accessories and put purple furniture in your thinking zones in your home.
    • Construct a purple visualization board to help you prioritize the most important things in your life.
    • Hang a map of the world inside a purple frame. Stick purple stick-pins into the places around the world that you'd like to visit or revisit.

  3. Be a social butterfly and build social support networks. A lonely brain tends to age faster and while you don't need to be the life and soul of the party, you do need the lift that regular connection with other people can provide you.
    • Don't just hang people of your own age group, especially if you're older. People tend to think similarly to those they spend time with and "feeling old" is catching
    • Older people tend to prefer to be around people they're most familiar with while younger people tend to enjoy meeting new people and getting to know a wider variety of people.[31] If you're going to keep your brain younger, think young by mixing up your social contacts and spending time with people in all age groups.

  4. Go back in time. Thinking about your youth, and of memories you had when you were young, can keep your brain young.
    • In 1979, a Harvard psychology professor Ellen Langer created an experiment in which elderly people were sent to live in a house set up as if it were 1959, 20 years earlier. They had to watch 1950s TV, wear clothing from the era and act as if they were living in the '50s. Those who participated in the study displayed improved recall, intelligence and even eyesight. They even appeared younger when before and after photos of them were compared.[32]
    • A study by John Bargh showed that people who thought about words related to aging slowed down after they did the test.[33] Aim to think mostly of words relating to youth, vitality, energy, and pep whenever you consider your own age.
    • Seek to see yourself as younger than your biological age. How you think about your age is as important as what you eat and how much you exercise. Much aging is in the mind. If you live and think like a younger person and your brain will definitely cooperate.

  5. Avoid multi-tasking. Multi-tasking reduces your brain's effectiveness and can cause you stress.[34] Instead, complete single tasks with greater focus.

  6. Reduce the time you spend watching TV. Instead, choose pastimes that are more interactive and require brain input. Only use TV viewing as an occasional treat.
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Cerebral Edema


 http://www.learningradiology.com/caseofweek/caseoftheweekpix2006/cow232arr.jpg

The Blood Brain Barrier (BBB):
The cerebral capillary is the site of the BBB. Interendothelial tight junctions impede the passage of electron-dense markers. Cerebral capillaries lack fenestrations and have tight junctions. They are active in the process of pinocytosis. All these features regulate the passage of highly polar hydrophilic molecules allowing virtually unrestricted passage of lipid-soluble substances. Cerebral capillaries have 2-4X the number of mitochondria as other capillaries. Cerebral capillaries have an array of important enzymes: ATPase, dehydrogenase, monamine oxidase, DOPA decarboxylase, acid and alkaline phosphatase, NAD and others. BBB has both central (cholinergic and aminergic) and peripheral (sympathetic and parasympathetic) innervation.

Areas without a BBB include:
  1. choroid plexus
  2. area postrema
  3. median eminence
  4. neurohypophysis
  5. pineal body
  6. subforniceal organ
  7. commissural organ
  8. supra-optic crest.
Carrier Mediated BBB Movement:
Glucose and aa's are actively transported as they are not lipid soluble. These substances demonstrate stereospecifity, competitive inhibition and saturation. May be bi- or unidirectional transport. All aa's appear to use the same active transport system (flooded in PKU, aminoaciduria's etc)

Evaluation of BBB function:
Using radio-isotopes or various exclusion dyes can calculate from single pass what Km and Vmax are.
In humans BBB integrity determined by: 
  1. external detection of radionuclide activity with a sodium iodide crystal
  2. CT scanning
  3. PET scan with rubidium-82
 CEREBRAL EDEMA:

Definition: Excess accumulation of water in the intra- and/or extracellular spaces of the brain.
Classification:
  1. Vasogenic edema:
    The disruption of the cerebral capillary provides the underlying mechanism for vasogenic edema. The amount of edema is greatest in the white matter (increased water and sodium in the extracellular spaces, decreased potassium); but the same changes may take place in grey matter but less so. The astrocytes become swollen. This type of edema is seen in response to trauma, tumors, focal inflammation, and late stages of cerebral ischemia.
  2. Cytotoxic edema:
    This is due to the derangement in cellular metabolism resulting in inadequate functioning of the sodium and potassium pump in the glial cell membrane. As a result there is cellular retention of sodium and water. There are swollen astrocytes in grey and white matter. Cytoxotic edema is seen with various intoxications (dinitrophenol, triethyltin, hexachlorophene, isoniazid) and in Reye's syndrome, severe hypothermia, and early ischemia.
  3. Osmotic edema:
    Normally CSF and ECF osmolality in the brain is slightly greater than that of plasma. When plasma is diluted by SIADH, water intoxication, hemodialysis, there is passage of water down abnormal gradient creating cerebral edema.
  4. Hydrostatic:
    This form of cerebral edema is seen in acute, malignant hypertension. It is thought to result from direct transmission of pressure to cerebral capillary with transudation of fluid into the ECF.
Pathophysiology of Cerebral Edema:
This is a cascade of events involving loss of the integrity of the BBB, setting up of a vascular hydrostatic gradient, increased tissue pressure, decreased cerebral blood flow, with resulting tissue acidosis. Chemical changes include glutamate, serotonin, components of kallikrein-kininogen-inin, fatty acids

Treatment:
  1. Surgical removal of offending lesion
  2. Control of arterial blood pressure
  3. Corticosteroids - stabilize membranes
  4. Osmotherapy - mannitol (1 g/kg); lasix 0.7 mg per kg; glycerol 1 g/kg
  5. Control of ICP - carbonic anhydrase, DMSO
References:
  • Harrigan MR, Cerebral salt wasting syndrome. Neurosurgery 38: 152-160, 1996


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